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I.

Introduction

Health is the most important asset you have. Without health, everything else in life becomes
meaningless. Some people can live well with minor health problems, while others are confined to
their homes or beds because of debilitating disease. Regardless of severity, everyone seeks a life
without any medical issues. When in a perfectly healthy state, you are free to live life to the
fullest.
Of course, health is more than just the absence of disease. There are many people who are
not formally diagnosed with a condition, but still exhibit signs of imperfect health. General
anxiety, lethargy, lack of energy, mental fog, and a disconnected mindset plague many otherwise
healthy people. Alleviating these impediments is critical to optimal living and societys progress,
but modern medicine has little to offer. Even for major diseases, traditional pharmaceutical
options can usually only help manage symptoms and delay disease progression. In too many
cases, synthetic pharmaceuticals are completely ineffective and impair health by causing terrible
side effects. While pharmaceuticals certainly help millions of people, better options are direly
needed for so many others. Furthermore, individuals having adequate success using conventional
therapies could benefit more from healing methods that lack side effects.
The endocannabinoid system (ECS) may be the ideal pharmacological target for restoring
overall health. This chemical messaging system is responsible for maintaining homeostasis, or
stable balance, in all vertebrates. When an organism is in homeostasis, there is an absence of
disease. Essentially by definition, if an organism is not in perfect homeostasis, there will be some
level of disease. How disease manifests is dependent on a variety of genetic and environmental
factors, but most conditions involve some dysfunction of the ECS.
Given the above fact, it makes sense that enhancing the ECS, as well as using medicines
that work within it, could potentially treat a wide variety of diseases. If homeostasis can be
restored, then theoretically diseases should go into remission. While the nature of ECS
dysfunction or deficiency varies between diseases, and thus may require different approaches,
the predominant goal of restoring normal function is always the same.
At its heart, the ECS is all about communication. When cells communicate efficiently,
everything works as it should. The body will be disease-free, and the mind will be clear and
focused. Every human should work to optimize their health as a means of preventing disease and
living well. By targeting the ECS, there is a clear map to achieving great health.
The ECS can be enhanced through a variety of non-cannabis and cannabis-based
techniques. Cannabis is especially powerful because its plant cannabinoids (phytocannabinoids)
are structurally similar to the endogenous cannabinoids (endocannabinoids) used by the ECS.
Phytocannabinoids mimic the actions of endocannabinoids, such as activating specific
cannabinoid receptors. Instead of the body needing to devote limited resources and energy to
producing more endocannabinoids, phytocannabinoids can take over the same roles and more
efficiently correct imbalances. There are also situations where it is simply impossible for the
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body to make enough endocannabinoids to overcome a disease state. While extracts from
cannabis are undoubtedly very valuable, it is critical to use other enhancement measures to
facilitate the bodys optimal use of phytocannabinoids.
The following section discusses the basics of the ECS, its role as a protective network,
and the research showing how it is connected to virtually any disease imaginable. It is not
completely necessary to understand all these scientific details, and many people may prefer to
skip to the ECS enhancement section. However, it is always good to know more about how
something works, and seeing the incredible research behind the ECS provides confidence that
enhancing it is really worthwhile.

II.

The Endocannabinoid Systems Components

The endocannabinoid system is a chemical messaging system in vertebrates that consists of

endocannabinoids, cannabinoid receptors, and enzymes that synthesize and degrade
endocannabinoids. These endogenous compounds produced within the body have similar
chemical structures to the external phytocannabinoids in the cannabis plant. The purpose of the
ECS is ultimately to maintain homeostasis in organisms, which consists of regulating stable
energy and hormone levels, neurotransmitter concentrations, temperature, and more.
The two primary endocannabinoids include N-arachidonoyl ethanolamine and 2arachidonoyl glycerol (2-AG) (McPartland, The Endocannabinoid). The former is better
known as anandamide. They are synthesized from essential fatty acids, including Omega-6 and
Omega-3 fatty acids like arachidonic acid and eicosapentaenoic acid (EPA) respectively.
Anandamide specifically is derived from N-arachidonoyl phosphatidylethanolamine via multiple
pathways (Pacher, Btkai, and Kunos). Therefore, if one pathway is blocked, others means of
production still exist. The compound is degraded by fatty acid amide hydrolase (FAAH). 2-AG is
generated from diacylglycerol by a biosynthetic enzyme known as diacylglycerol lipase alpha
(Pacher, Btkai, and Kunos). It is degraded by monoacylglycerol lipase (MAGL).
There are three other known endocannabinoids and one additional compound that may be
an endocannabinoid. These include 2-arachidonoyl glycerol ether (2-AGE), O-arachidonoyl
ethanolamine (also known as virodhamine), and N-arachidonoyl dopamine (Pacher, Btkai, and
Kunos). Lysophosphatidylinositol may be the sixth endocannabinoid based on its interaction
with a novel cannabinoid receptor (Pieiro and Falasca). Other endocannabinoid-like compounds
and analogs exist, like oleoylethanolamide and palmitoylethanolamide, but currently they are not
officially classified as endocannabinoids.

(Pacher, Btkai, and

Kunos)
Cannabinoid receptors are the next integral components of the ECS. These receptors are known
as G protein-coupled receptors (GPCRs), because attached to them are G (guanine nucleotide
binding) proteins. Compounds which activate receptors are known as agonist ligands.
Compounds which block receptors are known as antagonist ligands. When receptors are
stimulated by agonists, the G protein detaches from the receptor and attaches to something else.
This induces a biological response by initiating a signaling cascade (McPartland, The
Endocannabinoid). These cascades, or biochemical pathways, involve a series of second
messengers which amplify the signal produced by the ligand, and eventually affect molecules
producing the cellular response.
GPCRs have different subtypes, such as G0, Gi, and Gs. These subtypes indicate what the
G protein will subsequently couple to after receptor activation, such as ion channels or enzymes
(McPartland, The Endocannabinoid). The cannabinoid receptors couple primarily to the Gi and
Go subtypes, practically meaning they inhibit adenylate cyclase (a key regulatory enzyme
throughout nearly all cells) and activate ion channels respectively (Pacher, Btkai, and Kunos).
However, there are other subtypes affected by cannabinoid receptors, and different ligands can
preferentially activate different G protein subtypes (McPartland, The Endocannabinoid).
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The primary cannabinoid receptors are CB1 and CB2. CB1 is the most abundant receptor
in the mammalian brain, but is also found throughout the body in much lower concentrations
(Pacher, Btkai, and Kunos). Its activation is responsible for the psychoactive effect of
tetrahydrocannabinol (THC), one of the main compounds in cannabis. Distribution of CB1 is not
uniform; the highest concentrations are in the basal ganglia, hippocampus, cerebral cortex,
cerebellum, and amygdaloid nucleus. There are virtually no cannabinoid receptors in the
brainstem, which controls breathing. This layout explains why THC (cannabis-derived or
synthetic) and other CB1 agonists affect memory, emotion, cognition, motor function, and pain
(McPartland, The Endocannabinoid). Also, the lack of receptors in the brainstem accounts for
why overdosing on cannabis cannot cause death. However, there are numerous opioid receptors
in the brainstem, which is why opiate drugs have the potential to stop respiration.
CB2 receptors are distributed primarily throughout the immune and hematopoietic
systems, meaning the receptors are found on white blood cells and tissues in the spleen, lymph
nodes, bone marrow, and tonsils (Pacher, Btkai, and Kunos). In lesser quantities, they are found
in the brain, pancreas, and liver. Activation of CB2 receptors can be immensely therapeutic, but
unlike CB1, its stimulation does not cause psychoactivity. One of the chief effects of CB2
activation is a reduction in inflammation (Toguri et al.).
Although CB1 and CB2 are the most distinguished receptors in the ECS,
endocannabinoids bind with other receptors as well. The transient receptor potential vanilloid
type 1 (TRPV1), which provides sensations of extreme heat and pain as well as regulates body
temperature, interacts with anandamide. In fact, activation of TRPV1 regulates anandamide
synthesis (Tth, Blumberg, and Boczn). Cannabinoids also activate TRPV2. The image on the
previous page shows which receptors are activated by specific cannabinoids. As shown, most
endocannabinoids activate CB1 with the greatest efficacy and CB2 with low efficacy (indicated
by the >> symbol). 2-AG stands out as equally activating both CB1 and CB2 (indicated by the ~
symbol). Anandamide and N-arachidonoyl dopamine are also distinguished by their affinity for
TRPV1.
Compounds with a high tendency to bind to a specific receptor are said to have a high
affinity for that receptor. Endocannabinoids or phytocannabinoids with low affinities for certain
receptors can still activate them, but can usually only do so when significant quantities are
present or in other special situations.
Peroxisome proliferator-activated receptors are nuclear receptors found within cells.
Anandamide and oleoylethanolamide (OEA), the monounsaturated analog of anandamide,
mediate neuroprotection and lipid breakdown by activating PPAR-alpha (OSullivan). 2-AG and
anandamide activate PPAR-gamma to confer anti-inflammatory effects. This receptors
activation can also cause vasorelaxation in isolated arteries. More research is needed to identify
the effects of endocannabinoids on other subtypes of PPAR.
There are a number of receptors whose endogenous ligands we do not know. These
orphan receptors are designated with GPR and a number. Several such receptors may be novel
cannabinoid receptors, including GPR55, GPR119, and GPR18. Of these, GPR55 has received
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the most attention, although little is known about its function. It may be involved in pain
signaling and vasculature actions. Anandamide is the chief endocannabinoid agonist of GPR55;
interestingly enough, the plant cannabinoid cannabidiol (CBD) is an antagonist (Brown).
Evidence suggests that GPR119 works in the pancreas to regulate energy balance. It is activated
by OEA, and anandamide has measurable affinity for it as well (Overton, Fyfe, and Reynet).
Palmitoylethanolamide (PEA), another compound with endocannabinoid-like effects, is weakly
active at GPR119 (Brown).
N-arachidonoyl glycine (NAGly), an analog of anandamide, activates GPR18 (Burstein).
The receptor also responds to a synthetic form of CBD known as abnormal cannabidiol
(McHugh et al.). One of GPR18s primary functions is directing microglial migration in the
central nervous system. Microglia are immune cells in the brain which help protect neurons.
OEA, PEA, and NAGly are currently not considered to be true endocannabinoids, but
they are endocannabinoid-related compounds (Caraceni et al.; Burstein). They also work to
improve general ECS function. PEA, several of its analogs, and OEA act as entourage
compounds to reduce uptake and metabolism of anandamide, thereby increasing its concentration
(Jonsson et al.). Several plant cannabinoids also act through similar mechanisms to increase
anandamide. The status of endocannabinoid-like compounds may change as ECS science further
develops.
One of the key methods by which endocannabinoids maintain homeostasis is through
retrograde feedback. When neurons communicate, neurotransmitters are sent from the
presynaptic neuron to the postsynaptic neuron. Endocannabinoids travel in the reverse direction,
from the postsynapse to the presynapse, where they bind with presynaptic CB1 receptors to
reduce neurotransmitter release (Hermanson and Marnett). This reduction is achieved via
inhibition of N-type voltage-dependent calcium (Ca2+) channels. Another mechanism of
presynaptic regulation involves activation of G protein-coupled inwardly rectifying potassium
(GIRK) channels (Guo and Ikeda).
Uniquely, endocannabinoids are synthesized on demand from phospholipids in the
postsynaptic membrane. They are utilized when neurotransmission needs to be slowed down. In
essence, if a postsynaptic cell recognizes that a presynaptic cell is firing too rapidly,
endocannabinoids will be released upstream to instruct the sending cell to suppress or cease
transmission. Such recognition is usually triggered by increased intracellular calcium levels in
the postsynaptic cell. By completing the circuit of cellular communication, the ECS facilitates
whole-organism unity. Anandamide, 2-AG, and 2-AGE all exhibit similar levels of regulatory
efficacy; each displays approximately 50% maximal signal inhibition (Guo and Ikeda). Although
these endocannabinoids share efficacy, their potencies are different. 2-AGE is the strongest,
followed by 2-AG and anandamide. Therefore, it takes much less 2-AGE to achieve 50%
inhibition than anandamide.
Interestingly, whereas 2-AG and 2-AGE rely on the CB1 receptor to inhibit calcium
channels and neurotransmitter release, anandamide can inhibit such channels through a CB1-

independent mechanism (Guo and Ikeda). It may be that when one endocannabinoid cannot
induce inhibition via a certain mechanism, another utilizes a different pathway as an alternative.

(Velasco, Snchez and Guzmn)

Research surrounding the ECS is constantly expanding and changing. New receptors and
endocannabinoids will likely be discovered as the field advances. Although there is much more
to learn about how the ECS modulates health, it has already been linked in some way to virtually
every disease.

III.

The Endocannabinoid System and Disease Pathology

There is hardly a disease which the endocannabinoid system does not touch. While its
dysfunction or deficiency may not be the main cause of every disease, the ECS plays a major or
minor role in nearly everything.
An excellent article titled The Endocannabinoid System as an Emerging Target of
Pharmacotherapy, published in Pharmacological Reviews, is one of the best summaries of the
ECSs relationships with various diseases (Pacher, Btkai, and Kunos). The following is an
analysis of those relationships, which exemplifies the ECSs importance and the utility of
enhancing it. Unless otherwise noted, all information is derived from the aforementioned
Pharmacological Reviews paper. However, many of the details have been simplified due to the
remarkable specificity, complexity, and extensiveness of the article.
Obesity and Diabetes
One of the most recognized functions of the ECS relates to appetite. Most people know smoking
cannabis often increases the desire to consume food. This phenomenon is driven by THC
activating CB1 receptors. Anandamide and 2-AG also increase appetite through the same
receptor, and thus play a significant role in hunger-induced food intake. Endocannabinoids are
involved in both initiation and consummation of eating, interacting with a variety of orexigenic
(appetite stimulant) and anorexigenic (appetite suppressant) hormones and neurotransmitters.
These processes help maintain energy homeostasis.
CB1 receptors do more than just encourage appetite; they also affect peripheral energy
metabolism. They are expressed on fat cells, where their activation regulates hormone and
enzyme production and activity. The receptors help the body store energy as fat. In general,
endocannabinoids regulate energy homeostasis by interacting with central and peripheral
targets, including adipose [fat] tissue, muscle, liver, and endocrine pancreas (Bermdez-Silva et
al.)
Given these properties, it is no surprise the ECS affects obesity. While there are many
cases where endocannabinoid deficiency contributes to disease pathology, excessive activity of
the ECS is linked to weight gain. The CB1 receptor is particularly important. Endocannabinoids
and CB1 receptors are upregulated in the liver and fat tissues in various forms of obesity. Drug
antagonists of the CB1 receptor can significantly reduce caloric intake and weight in obese
animals and humans. Mice genetically engineered to lack the CB1 receptor (CB1 knockout mice)
resist diet-induced weight gain, even when consuming a high-fat diet.
From an evolutionary viewpoint, the function of CB1 receptors to conserve energy is
integral to survival. Animals, including humans, constantly endured famine during evolution.
The ability to store energy efficiently, as mediated by the ECS, was necessary. At no point
during evolution did organisms have free, almost unlimited access to high-fat and high-sugar

foods (Neuschwander-Tetri). In this new environment the ECSs protective mechanisms

backfire, storing too much energy and causing obesity.
Given the ECSs involvement in so many different areas throughout the body, it makes
sense that increased endocannabinoid activity could cause problems in some instances. However,
directly blocking this activity with drug antagonists has proven problematic, as CB1 receptors
control a lot more than weight. Other techniques must be used to correct this imbalance,
including dietary and lifestyle changes.
Curiously, cannabis consumption has been found to negatively correlate with obesity.
This phenomenon succinctly demonstrates the complexity of cannabinoid medicine and the ECS.
After all, cannabis activates CB1 receptors, so theoretically it should increase weight gain via
appetite stimulation and peripheral energy regulation mechanisms. However, that does not seem
to be the general case. The concurrent activation of CB2 receptors and receptor-independent
effects by THC and other cannabinoids may help explain the negative correlation.
A 2011 study using two sets of high-quality survey data found that obesity rates are about
a third lower in people smoking cannabis at least three times a week than people who do not use
cannabis at all (Strat and Foll). This correlation was maintained even after other factors were
accounted for, like cigarette smoking, age, and gender.
A later 2013 study determined that current cannabis users had 16% lower fasting insulin
levels and a 17% lower homeostasis model assessment of insulin resistance (HOMA-IR) score
(Penner, Buettner, and Mittleman). Furthermore, the cannabis users had higher levels of highdensity lipoprotein, the good kind of cholesterol, as well as a smaller waist circumference.
People who had used cannabis more recently had better measures.
Significant anecdotal evidence of overweight or obese individuals achieving healthier
weights with cannabis extracts has accrued over the past several years. Therefore, while cannabis
consumption has not been outright proven to control weight or improve insulin measures, it
clearly does not lead to widespread weight gain and may offer therapeutic options.
The above evidence suggests that the ECS is involved in glucose regulation and
potentially diabetes. Indeed, there are many studies which implicate the ECS in these functions.
CB1 activation has been found to impair plasma glucose clearance, while CB2 activation
facilitates glucose clearance (Di Marzo). Cannabinoid receptors are found in alpha and beta cells
of the pancreas, where they regulate glucagon (increases plasma glucose) and insulin (decreases
plasma glucose) release respectively. Unbalanced endocannabinoid concentrations can increase
intra-abdominal fat, thus contributing to atherosclerosis and type 2 diabetes (Di Marzo).
Anandamide and 2-AG are upregulated in non-obese patients with type 2 diabetes.
A 2008 study using CBD further bolstered the ECSs connection to diabetes (Weiss et
al.). Mice in a latent diabetes stage or with initial symptoms of diabetes were administered CBD
or no treatment. Only 32% of the CBD-treated group was diagnosed with diabetes, whereas the
figure was 100% for the untreated group (Weiss et al.). While it is clear endocannabinoids at
least partially modulate obesity and diabetes, more research is much needed.

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Pain Disorders
Pain is a symptom of many diseases and a condition in itself. Severe pain is one of the worst
things someone can live with, and there are few medical options available for those with longterm, chronic pain. The ECS is deeply involved in pain signaling, and its manipulation with
phytocannabinoids has been proven in clinical trials to benefit multiple forms of pain.
Anandamide, THC, and CBD can effectively reduce acute pain stemming from
mechanical, chemical, or thermal stimuli. They also work against neuropathic and inflammatory
chronic pain conditions. Acetaminophen, the most commonly used painkiller, confers its
analgesic effects indirectly through CB1 activation (Mallet et al.). Endocannabinoids work
synergistically with non-steroidal anti-inflammatory drugs to enhance their efficacy.
CB1 receptors are distributed throughout areas of the central and peripheral nervous
systems associated with pain. Anandamide confers its analgesic effects predominantly through
CB1 receptors, and levels of the compound increase in relevant brain areas after pain
experiences. CB2 receptors are also involved, most notably with inflammatory pain. The TRPV1
receptor may mediate some of the analgesic effects of anandamide, but more research is needed
(Starowicz et al.).
Inflammation is a major contributor to several forms of pain, as well as the development
of chronic diseases. This complex immune response to injury can induce tissue swelling, which
presses against nerves to cause pain. Chemicals released during the inflammatory process
increase pain as well.
Cannabinoid receptors, especially CB2, are an integral part of immune function. CB2
receptors are expressed on immune cells; the magnitude of their expression is affected by stimuli
that activate the immune system. The response to toxins also increases endocannabinoid levels,
which regulate immune function through receptor-dependent and independent mechanisms.
Specifically, cannabinoids modulate inflammatory cell signaling proteins (cytokines) like tumor
necrosis factor-alpha and interleukin-6, as well as many other signaling molecules. They also
affect the migration, proliferation, and apoptosis of inflammatory immune cells. This evidence
demonstrates how the ECS is deeply embedded in immune function, and how influencing it
could profoundly benefit disorders stemming from excessive inflammation.
It is likely the ECS interacts with the endogenous opioid system, as activation of
cannabinoid receptors may release endogenous opiods. Since the ECS communicates with many
other bodily systems, and is so intertwined in pain signaling, its interaction with endorphins is
logical.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a relatively prevalent pain condition that arises from chronic
autoimmune inflammation. The inflammation progressively destroys joints, leading to

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continuously impaired function and increased pain. By targeting inflammation and suppressing
overactive immune activity, the ECS could dramatically alleviate RA.
In many animal studies, various plant and endogenous cannabinoids have been shown to
benefit RA through anti-inflammatory, analgesic, and immunosuppressive mechanisms.
Analgesia is largely mediated through CB1 receptors whereas immune-related effects are
mediated through CB2 receptors. CBD reduces inflammatory markers like tumor necrosis factoralpha and stops progression of collagen-induced arthritis in mice. Anandamide and THC are
effective against arthritis-related pain. This evidence suggests RA progression may be connected
to an endocannabinoid deficiency, and that using CB1/CB2 agonists could provide significant
benefit.
A double-blind, placebo-controlled trial found that a mix of THC and CBD produced
significant analgesic effects and reduced disease activity in patients with RA (Blake et al.). More
research is needed in many areas surrounding RA, including studies with larger patient
populations and preclinical exploration of further ECS involvement. However, the existing
evidence and proven effectiveness of cannabinoids confirms an important role of the ECS in RA
pathology and treatment.
Neurodegenerative Disorders and Neuroprotection of the ECS
A critically important job of the ECS is to protect the body from all kinds of harm, including
damage originating from internal or external sources. With physical injuries, the ECS contributes
to healing and neuroprotection. Having a strong ECS could even improve survivability from
head trauma, as discussed later in this section.
Studies have implicated the ECS in conferring neuroprotection in a wide variety of cases,
including acute injuries and chronic neurodegenerative diseases. From traumatic brain injuries to
multiple sclerosis to Alzheimers, the ECS is involved in nearly everything.
There are a few common mechanisms by which cannabinoids mitigate neurotoxicity.
Retrograde feedback is an especially integral tool. In many cases, neurotoxicity stems from
overstimulation of neural receptors by the excitatory neurotransmitter glutamate. Too much
glutamate causes neurons to die. Endocannabinoids travel upstream from the postsynaptic to the
presynaptic neuron, where they bind with CB1 receptors and instruct the sending cell to stop
firing. This mechanism reduces destructive excitatory transmission (excitotoxicity) and protects
cells.
The ECS offers additional protection by extensively influencing neuronal and nonneuronal signaling. Endocannabinoids modulate the release of inflammatory mediators from
many cell types (astrocytes, microglia, macrophages, lymphocytes, neutrophils, and neurons) via
CB1, CB2, and other receptors. Since excessive inflammation often leads to neurodegeneration,
these mechanisms can be quite powerful.
The ECS activates multiple cytoprotective signaling pathways and regulates calcium
homeostasis by affecting calcium, potassium, and sodium channels, as well as non-cannabinoid
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receptors. In certain situations, the ECS may protect cells by reducing metabolic rate and oxygen
demand through a CB1-depedent mechanism. Lack of oxygen causes cell death, so if
endocannabinoids can reduce the need for oxygen, this would enable cells to survive longer.
Another strong contributor to neurotoxicity is oxidative stress, which results from an imbalance
of free radicals. Cannabinoids act as antioxidants and disable these radicals. Oxidative stress can
also result from excitotoxicity, in addition to causing it. Therefore, cannabinoids can reduce
oxidative stress by stopping it at its source (preventing excitotoxicity) and disabling radicals
directly.
Many of the processes triggered by traumatic brain injury (TBI), such as excitotoxicity,
inflammation, and cell death, could effectively be reversed with cannabinoid therapies.
Endocannabinoids like 2-AG increase in direct response to injury, as an apparent attempt by the
body to protect cells. Anandamide and 2-AG protect neurons in the cerebral cortex from glucose
and oxygen deprivation.
The above information suggests that enhancing the ECS or using phytocannabinoids
could therapeutically benefit head injuries. Indeed, an October 2014 study solidly demonstrated
the reality of cannabinoid neuroprotection. Researchers analyzed 446 patients treated for TBI,
and compared results from those testing positive for THC to those testing negative. After
adjusting for factors like injury severity, THC-positive patients were found to have an 80% lower
probability of dying than THC-negative patients (Nguyen et al.). These are incredible results, but
more research is needed to determine the effective doses of THC along with the potential utility
of other cannabinoids like CBD.
Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune disease caused largely by the inflammation-mediated
loss of neural myelin sheaths, which amplify communications between neurons. Like most
neurodegenerative disorders, MS gets worse with time as more neurons lose their sheaths and
die.
CB1 and CB2 receptors influence spasticity and tremors, two common symptoms of MS.
Mice with experimental autoimmune encephalomyelitis (EAE, a lab-model of MS) given
cannabinoid receptor antagonists experienced worsening of these symptoms. Naturally higher
levels of anandamide, 2-AG, and PEA are found in areas with nerve damage; like brain injury,
this is an apparent survival mechanism to protect cells.
Further evidence of ECS involvement comes from mice bred without CB1 receptors. CB1
knockout mice have revealed much about the receptors function. First, the mice cannot tolerate
inflammatory or neurotoxic damage well, and have naturally higher levels of pro-apoptotic
compounds in their cells. CB1 knockout mice with EAE experienced greater cell death and more
myelin sheath and axonal protein loss than regular mice. These results suggest the CB1 receptor
has a general neuroprotective function.

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In humans, those with an active form of MS have a higher concentration of anandamide

than those with a silent form (Eljaschewitsch et al.). The ECS is activated during nervous system
inflammation and protects neurons from damage through the complex modulation of enzymes.
Double-blind, placebo-controlled trials have determined that THC and CBD therapeutically
improve many aspects of MS, including pain, spasticity, bladder problems, and mobility issues
(Rog et al.; Wade et al.). Therefore, it has been conclusively proven that ECS manipulation can
benefit MS.
Parkinsons Disease
Parkinsons Disease (PD) is a neurodegenerative disorder characterized by impairments in motor
function and coordination. It is caused by a loss of dopamine-producing (dopaminergic) neurons,
although exactly what leads to their death is unknown. Many of the factors involved in MS, such
as excitotoxicity, oxidative stress, and inflammation, are also present in PD, which suggests it
too can benefit from ECS therapy.
PD causes problems with movement because most of the dying neurons are found in the
basal ganglia, which helps control motor function. CB1 receptors and endocannabinoids are
highly abundant in these regions, and become dysregulated in experimental models and human
forms of movement disorders. A feature of these disorders is that CB1 receptors often increase in
the basal ganglia, which may be a mechanism of normalizing motor function in a dopaminedeficient state. This theory is supported by the fact that CB1 agonists confer numerous benefits.
These include decreasing tremors, reducing motor impairment, and preventing dopaminergic cell
death. However, overactivity of CB1 signaling may be associated with some symptoms of PD,
like bradykinesia (slow movement). Depending on the individual manifestations of PD, different
ECS-based treatments will likely be warranted.
Amyotrophic Lateral Sclerosis
One of the fastest progressing neurodegenerative diseases is amyotrophic lateral sclerosis (ALS).
It results from rapid degeneration of motor neurons in the brain and spinal cord, which ultimately
paralyzes most patients and leads to death within 3 to 5 years. Cannabinoids can benefit ALS by
reducing excitotoxic and oxidative damage, but unlike MS and PD, the neuroprotective effects
are apparently mediated by non-CB1 receptor mechanisms.
The utility of cannabinoids for ALS is efficiently summarized in a 2010 study. The
authors state, Ideally, a multidrug regimen, including glutamate antagonists, antioxidants, a
centrally acting anti-inflammatory agent, microglial cell modulators (including tumor necrosis
factor alpha [TNF-alpha] inhibitors), an antiapoptotic agent, 1 or more neurotrophic growth
factors, and a mitochondrial function-enhancing agent would be required to comprehensively
address the known pathophysiology of ALS. Remarkably, cannabis appears to have activity in all
of those areas (Carter et al.).
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Alzheimers Disease
A large percentage of people develop some form of dementia as they get older. The most
common form is Alzheimers Disease (AD). It begins with the accumulation of beta-amyloid
plaque and hyperphosphorylated tau protein, which leads to neuroinflammation and cell death.
While there are currently no conventional options to safely and effectively treat AD, the ECS
offers a promising route for dealing with this traumatic condition.
As with other forms of neurodegeneration, the CB1 receptor is closely linked to
mitigating the underlying biological processes of AD. Anandamide, working through CB1,
inhibits neurotoxicity via numerous mechanisms. It activates cytoprotective pathways and dosedependently inhibits release of nitric oxide, a molecule which may be responsible for the
neurotoxic effects of beta-amyloid plaque. Interestingly, CB1 receptors decrease while CB2
receptors increase in the brains of AD patients. Endocannabinoids may be released from neurons
and glial cells in response to beta amyloid deposition, where they activate neuroprotective
pathways via CB1 and modulate inflammation via CB2.
The synergistic potential of co-activating CB1 and CB2 receptors was explored in a small
study with six patients suffering from late-stage dementia. The patients were given small doses
of synthetic THC, which activates CB1 and CB2, at doses of 2.5mg daily for two weeks (Walther
et al.). Despite the low doses and short timespan, the treatment was very effective at improving
symptoms, including aberrant motor behaviors, nighttime behaviors, agitation, and general
neuropsychiatric measures.
Another observation in AD is that the anandamide-metabolizing enzyme FAAH becomes
overexpressed. Too much FAAH decreases anandamide levels and thus limits its neuroprotective
capabilities. CBD, which inhibits the degradation of anandamide, could potentially be even more
effective than THC for AD. A 2014 study administering CBD to AD-mice elicited strong results
(Cheng et al.). Dr. Tim Karl, one of the studys authors, stated, It basically brings the
performance of the animals back to the level of healthy animals. You could say it cured them,
but we will have to go back and look at their brains to be sure (Corderoy). CBD also directly
reduces amyloid precursor protein (APP). As the name suggests, this molecule is the precursor to
beta amyloid protein, so inhibiting it could effectively reduce plaque.
Epilepsy
Epilepsy is a term that encompasses a wide range of disorders characterized by seizures. The
seizures derive from uncontrolled electrical activity in the brain, but what causes the underlying
problem is unknown. Since one of the ECSs prime functions is to inhibit excitatory
transmissions, its role in epilepsy is not surprising.
Strong evidence implicates the CB1 receptor in abolishing and likely preventing seizures.
Presynaptic CB1receptors are upregulated in epileptic rats, and the levels of anandamide and 215

AG increase during seizure activity, suggesting a protective role of the ECS. Anandamide dosedependently decreases electroshock-induced seizures in rats via CB1; blocking the receptor
increases seizure frequency. Activation of CB1 receptors may protect against excitotoxicity by
inhibition of calcium channels, stimulation of potassium channels, and activation of enzymes.
The use of CBD to treat epilepsy has proven effective, as indicated by observational
studies and mass anecdotal evidence (GW Pharmaceuticals). In practice, cannabis extracts rich
in CBD are effective for controlling many types of epilepsy, although not all patients respond to
the therapy. Since CBD enhances anandamide signaling and thus indirectly activates CB1
receptors, relatively high efficacy is to be expected. Other plant cannabinoids, including CBDV
and even THC, have shown promise as anticonvulsant agents.
Mental Disorders
A healthy mental state is maintained by balanced electrical and neurotransmitter activity in the
brain. When this activity becomes dysfunctional, a wide range of mental disorders can arise. The
ECS offers hope as a therapeutic option. Several mechanisms that benefit neurodegenerative
disorders, like retrograde feedback, may also have relevance in healing mental conditions.
Schizophrenia
As the second most common mental disorder and one of the most psychologically debilitating,
schizophrenia severely impairs quality of life for millions throughout the world. The condition
features positive and negative symptoms, in which abnormal behaviors are present and normal
behaviors are absent, respectively. Positive symptoms include delusions and hallucinations,
while negative symptoms consist of apathy, inability to experience pleasure, and loss of
motivation. The manifestation of these symptoms varies significantly in different individual
patients.
The involvement of the ECS in schizophrenia is more layered due to the numerous
underlying biological processes that cause symptoms. A deficiency in glutamate or dopamine
transmission may underlie negative symptoms, whereas overactive dopamine transmission may
drive positive symptoms. Interestingly, an overactive ECS could lead to both excessive
dopamine and deficient glutamate signaling. The psychoactive cannabinoid THC has been
shown, in some cases, to cause psychotic symptoms in healthy individuals and precipitate
psychosis in susceptible individuals. There is also increased CB1 receptor density in certain parts
of the brain in schizophrenic patients, as well as higher levels of anandamide in the blood.
The above evidence suggests blocking the CB1 receptor or inhibiting anandamide could
treat schizophrenia. Yet curiously, the opposite effect has proven beneficial; again, it may be that
upregulation of CB1 and anandamide is an attempted protective mechanism. A 2012 doubleblind, randomized clinical trial compared CBD to the traditional antipsychotic amisulpride. It
found CBD was generally as effective as amisulpride, and even suggested the cannabinoid was
16

more effective in alleviating negative symptoms (Leweke et al.). It also had very few side
effects. Patients taking CBD experienced increases in serum anandamide levels, which the
authors suggested may contribute to antipsychotic effects.
In this case, the seemingly contradictory observations clearly indicate the need for more
research. However, it is also clear the ECS is involved in schizophrenia, and modulating it can
produce clinically-significant benefits.
Anxiety
The role of cannabinoids in anxiety is the perfect example of the bidirectional effects of the ECS.
When there is too much or too little of something, the ECS exerts its characteristic homeostasisrestoring effects to increase or decrease a factor. The ECS and especially plant cannabinoids are
also biphasic - low doses induce one response, whereas high doses cause an opposite response.
CB1/CB2 agonists have been shown, in small quantities, to confer anxiolytic (antianxiety) effects.
The same agonists can cause anxiety in higher doses. The reason for this is currently unknown,
but may relate to the distribution of receptors in the brain and their varying sensitivities to
cannabinoid receptor agonists.
The high concentration of CB1 receptors in brain regions associated with anxiety
regulation suggests the ECSs involvement in controlling anxiety. For example, the blockade of
CB1 increases anxiety. In this case, it is interesting that both blocking and overstimulating the
CB1 receptor has the same effect, further demonstrating the remarkable complexity of the ECS.
Depression
The initial causes of depression can be varied, but underlying neurological processes factor into
virtually all forms of the condition. Neurogenesis, the formation of new brain cells, decreases
under depressive and high-stress conditions. It is possible that impaired neurogenesis also
contributes to depression. The ECS and phytocannabinoids alike promote neurogenesis, and
evidence suggests CB1 receptors are required for survival of neurons in the hippocampus. The
ECS has been implicated in having an anti-depressant function, and augmentation of the system
has anti-depressant events (Patel and Hillard).
The role of CB1 in depression is significantly supported by the effects of traditional
antidepressants. Specifically, chronic tricyclic antidepressant treatment increases CB1 density in
the hippocampus and hypothalamus, which may mediate the treatments therapeutic effects.
Increasing anandamide, which enhances activation of CB1receptors, produces antidepressant-like
effects. The anti-inflammatory properties of the ECS may also be involved in controlling
depression. However, like anxiety, long-term overstimulation of CB1receptors could potentially
induce depression.

17

Cardiovascular Disorders
The ECS is extensively involved in cardiovascular regulation. It has direct effects on vasculature
and myocardium (heart muscle) function. CB1 receptors mediate many cardiovascular processes,
including vasodilation. CB2 and TRPV1 receptors may also be involved in some of these
functions, but CB1 is apparently dominant. Depending on the specific condition, the relevance of
different receptors varies.
Hypertension
High blood pressure is a problem that is most dangerous because of what it can lead to.
Hypertension damages the arteries, heart, brain, kidneys, eyes, and more (High Blood).
Anandamide and THC lower blood pressure by activating CB1 receptors. These hypotensive
effects are greater in hypertensive individuals than those with normal blood pressure, suggesting
cannabinoids exert stronger effects when a metric is too far from homeostasis. In mice and rats
with regular blood pressure, both CB1 agonism and antagonism cause little change. However, in
hypertensive rats, CB1 antagonism further increases blood pressure. This suggests CB1 receptors
only get significantly involved when blood pressure becomes dysregulated.
The ECS may play a key role in limiting high blood pressure levels through CB1
receptors. They become upregulated in hypertensive rats, which enhances the cardiovascular
effects of anandamide. The ECS seems to increase activity when necessary, upregulating itself to
reduce blood pressure and prevent hypertension.
Atherosclerosis
Like hypertension, atherosclerosis causes numerous other cardiovascular problems, including
increased risk of heart attack or stroke. It is characterized by accumulation of immune cells,
cholesterol, and fat in arteries, which leads to plaques that inhibit blood flow. Inflammation and
oxidative-nitrosative stress are major components of atherosclerosis. Given the antiinflammatory and antioxidant functions of cannabinoids, they may be ideal compounds for
treating hardened arteries.
CB2 receptors are expressed on immune cells in human atherosclerotic plaque. THC
exerts several anti-inflammatory effects via CB2 activation, including the inhibition of white
blood cell movement. In mice, THC significantly slows progression of atherosclerosis. The CB1
receptor does not seem to be largely involved, despite the fact that other aspects of
cardiovascular regulation are primarily controlled through CB1. Therefore, 2-AG is likely the
ECS component most responsible for controlling atherosclerosis, as it is the only
endocannabinoid with a strong affinity for the CB2 receptor. Other endocannabinoids and
phytocannabinoids may benefit atherosclerosis through additional mechanisms, such as receptorindependent antioxidant effects.
18

Ischemia
When there is restricted blood flow to the heart, brain, or other parts of the body, cells cannot
absorb the nutrients required for survival. Heart attacks and strokes occur in extreme acute cases
of ischemia and can be fatal. Atherosclerosis and hypertension are high risk factors for this
condition.
The role of the ECS in ischemia is illuminated by the effects of CBD, which enhances
anandamide signaling and activates numerous types of receptors. A 2010 study administered
CBD to mice before induction of coronary ischemia or before reperfusion (the restoration of
blood flow after it has been cut off) (Walsh et al.). Like ischemia, reperfusion can damage cells.
CBD caused a dose-dependent reduction in tissue death when given prior to ischemia and
reperfusion. It also attenuated the number of irregular heartbeats.
Another 2010 study examining CBDs effects on a diabetes-related heart problem
revealed more about the compounds protective benefits (Rajesh et al.). CBD reduces many
types of inflammatory and fibrosis biochemical markers as well as oxidative and nitrative stress.
At least partially through these mechanisms, it can normalize general myocardial dysfunction.
CBD also protects human heart cells from the increased free radical damage induced by high
glucose exposure (Rajesh et al.). While more research is needed on the ECS and ischemia, the
effectiveness of plant cannabinoids demonstrates it must have some role.
Eye Disorders and Glaucoma
One of the earliest modern uses of medicinal cannabis was for eye disorders. Glaucoma is the
most well known of these disorders, and involves abnormally high intraocular pressure (IOP)
that eventually leads to blindness. Significant evidence implicates the ECS in the regulation of
IOP. CB1 receptors and endocannabinoids are found in many parts of the eye, including the
retina, where their activation lowers IOP. CB2 receptors are much sparser and activating them
has little to no effect, indicating their lack of relevance in managing glaucoma.
The importance of endocannabinoids for IOP regulation was suggested in a 2005 study
that compared endocannabinoid content in normal and glaucomatous eyes (J. Chen et al.). The
glaucoma patients eyes had significantly decreased levels of 2-AG and PEA, as well as
somewhat lower levels of anandamide. The endocannabinoids were found to have decreased in a
specific tissue associated with IOP regulation, the ciliary body. Several mechanisms contribute to
the pressure-reducing ability of cannabinoids, including vasodilation and retrograde feedback.
By acting through presynaptic CB1 receptors, cannabinoids inhibit norepinephrine release and
production of aqueous humors. Other pathways may also help lower IOP.
The ECS is likely involved in other eye disorders besides glaucoma. Cannabinoids
protect against retinal neurotoxicity and have powerful anti-inflammatory effects, making them
potential candidates for the treatment of many inflammatory and degenerative eye disorders.
19

Phytocannabinoids like THC and CBD have been shown to reduce intraocular pressure and
preserve the blood-retinal barrier in diabetes, respectively.

Inflammatory Bowel Disease

Inflammatory bowel disease refers to ulcerative colitis and Crohns disease, which are
inflammatory conditions of the intestines. Severe abdominal pain, malnutrition, and other
problems often result from inflammation. The ECS is involved in many functions of the
gastrointestinal system, including gastric acid secretion and gastrointestinal motility (the
movement of food through the gastrointestinal system via muscle contractions). Pain and
malabsorption of nutrients can be caused by increased motility, which itself is a symptom of
inflammation.
CB1 receptors are widely distributed across the enteric (gastrointestinal) nervous system,
along with the endocannabinoids anandamide and 2-AG. CB2 receptors are also present,
including on macrophage white blood cells (which lack CB1 receptors). CB1 and CB2 receptor
activation inhibits gastrointestinal motility, although depending on the situation one or both of
the receptors may mediate the effects. A clinical trial with a CB1 antagonist found increased rates
of diarrhea, suggesting CB1 receptor blockade hastens motility. Furthermore, mice with intestinal
inflammation had an increased quantity of intestinal CB1 receptors, which accounted for the
enhanced efficacy of cannabinoids in regulating motility. Mice genetically programmed to lack
CB1 receptors experience greater inflammation than wild-type mice with CB1 receptors.
Numerous studies have shown anandamide protects against colitis. As with other conditions,
cannabinoid receptors and endocannabinoids may become upregulated as a protective
mechanism.
The effectiveness of phytocannabinoid therapy for Crohns disease was examined in a
2013 double-blind, placebo-controlled study (Naftali et al.). 5 of 11 subjects in the cannabis
group achieved complete remission compared to only 1 in the placebo group. Almost all of the
cannabis subjects, 10, experienced significant therapeutic benefits, compared to 4 in the placebo
group. The cannabis group also reported better appetite and sleep, with no strong side effects.
The scientific and clinical evidence has undeniably demonstrated the utility of ECS manipulation
for inflammatory bowel disease, yet more trials are needed in larger populations.
Liver Disease
Liver disease encompasses more than a hundred specific conditions. The most well known
sources of damage to the liver include hepatitis C and excessive alcohol consumption. Some
autoimmune diseases also attack the liver. Cirrhosis is a common result of prolonged damage. It
is characterized by the formation of fibrous scar tissue, which inhibits the ability of the liver to

20

add and remove substances from blood. Furthermore, scar tissue can cause other complications
like localized hypertension.
CB1receptors are distributed throughout various specialized cells of the liver. CB2
receptors appear in cirrhotic but not normal liver tissue, indicating they may help prevent the
production of more scar tissue. Indeed, mice without CB2 receptors have worse liver fibrosis than
regular mice, and CB2 stimulation inhibits the activated liver stellate cells which generate scar
tissue.
Endocannabinoids are present in the liver at concentrations similar to those in the brain.
Like CB2 agonists, anandamide confers antifibrogenic effects by inhibiting or killing stellate
cells, although the effects are mediated by mechanisms not related to CB1/CB2 or TRPV1. In fact,
CB1 receptor activation may increase fibrogenesis, as indicated by the ability of CB1 antagonists
to slow progression of liver fibrosis. Therefore, ECS-related treatments that avoid direct
activation of CB1 are probably best suited for liver disease.
Cancer
There are over 100 different types of cancer, but they all share the properties of uncontrolled
abnormal cell proliferation and potential of abnormal cells to spread to other tissues (What is
Cancer). In a multicellular organism, individual cells are born with the internal machinery to
undergo programmed cell death, also known as apoptosis. When they become damaged or aged,
cells will kill themselves for the benefit of the organism. Cancerous cells lose the ability to selfinduce apoptosis, continuing to reproduce when they should otherwise die. Strong evidence
suggests the ECS protects against cancer, and the progression of malignant cancers may be a
failure of the ECS to adequately execute its protective function.
The role of the ECS in cancer is apparent by the anti-cancer effects of endocannabinoids.
Anandamide induces apoptosis in neuroblastoma and lymphoma cells via the TRPV1 receptor
(Maccarrone et al.). Palmitoylethanolamide (PEA) and oleoylethanolamide (OEA) also work
with anandamide to inhibit neuroblastoma cell proliferation through CB1/CB2- and TRPV1independent mechanisms (Hamtiaux et al.). An analogue of anandamide was found to inhibit
adhesion and migration of breast cancer cells via a CB1 receptor-dependent mechanism in a 2006
study, which also stated the ECS regulates cancer cell proliferation in human breast cancer
(Grimaldi et al.). Another study found the development of precancerous lesions in mice was
associated with an increase in 2-AG, and that increased endocannabinoid levels reduced the
development of those lesions (Izzo et al.).
Cannabinoid receptors become upregulated in certain types of breast and prostate
cancers, and likely other cancers as well (Caffarel et al.; Carracedo et al.). This upregulation,
combined with the pro-apoptotic and anti-proliferative capabilities of endocannabinoids,
suggests that the ECS intimately protects against cancer. If normal cells are programmed to
develop more cannabinoid receptors when they become cancerous, they would become more
susceptible to the anti-cancer effects of endocannabinoids.
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The importance of cannabinoid receptors for cancer survival was demonstrated in a 2006
study. Researchers examined the expression levels of CB1 and CB2 receptors in liver cancer
patients, and determined through statistical analysis that patients with high expression levels had
significantly better disease-free survival than patients with low expression levels (Xu et al.). This
makes sense, as individuals with more cannabinoid receptors have more opportunities for their
endocannabinoids to kill cancer cells.
A multitude of phytocannabinoids and endocannabinoids, including THC, CBD,
anandamide, and 2-AG, can induce apoptosis in the following types of cancer cells: Glioma,
astrocytoma, neuroblastoma, breast, prostate, colon, thyroid, pancreatic, leukemia, lymphoma,
pheochromoctyoma, and more. Conversely, some studies have found that cannabinoids can
encourage proliferation of cancer cells. However, this pro-proliferative effect usually only occurs
when very small concentrations of cannabinoids are used, and only in certain cases. The vast
majority of the evidence indicates phytocannabinoids and endocannabinoids have predominantly
anti-cancer activity.
Human evidence indicates phytocannabinoids can protect against cancer. A 2009 study
found that moderate cannabis consumers with 10 to 20 years of use had significantly reduced
rates of head and neck squamous cell carcinomas (Liang et al.). Cannabis smokers also do not
have higher rates of lung or upper airway cancer, despite the presence of carcinogens in cannabis
smoke (Tashkin). Most importantly, a 2013 study directly linked cannabis extract intake to
abolishment of leukemic cancer cells in a human patient (Singh and Bali).
The ECS has a clear role in cancer regulation, and phytocannabinoids have a definite
place in future cancer care. More research is desperately needed to find which cancers respond
best to different types of cannabis extracts in different patient populations.

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IV.

Enhancing Your Endocannabinoid System

As the previous section demonstrates, the endocannabinoid system is involved in practically

every major disease. In most cases, a deficiency of endocannabinoid activity contributes to
disease, but excess activity can also be pathological. The aim of enhancing your ECS does not
necessarily entail upregulating cannabinoid receptors and endocannabinoids throughout your
whole body, although it may. Healthy practices that support your ECS will help it regulate itself,
including increasing or decreasing receptors and endocannabinoids where necessary. Ultimately,
ECS empowerment can help anyone return to true homeostasis.
The practices discussed below are non-cannabis methods of ECS enhancement. The use
of phytocannabinoids as a tool for enhancement is examined after these methods. Cannabis
extracts are certainly one of the most powerful ways to support your ECS. However, direct
ingestion of cannabis, especially long-term consumption of extracts with high levels of
psychoactive THC, seems to be one of the few ways that ECS function could be dysregulated
through overstimulation. As described earlier, THC and particularly excessive CB1activation
contribute to pathology in certain cases. It is very difficult and perhaps even naturally impossible
to overstimulate your ECS through non-phytocannabinoid techniques. Despite the potential for
harm, the actual and comparative risk of THC consumption is extremely low, and long-term
ingestion of extracts with a balanced phytocannabinoid profile is probably good for most people.
Strengthening the ECS through other means would likely reduce the amount of
phytocannabinoid supplementation necessary for many patients.
Nutrition
Nutrition is arguably the most important factor in the health of the ECS. The foods you eat can
be the ECSs greatest source of fuel or its biggest challenge. Avoiding harmful foods
substantially aids the ECS by reducing the amount of protective work it must perform. For
example, foods that cause inflammation will increasingly deplete endocannabinoids, as they
work to reduce inflammation. A regular diet that incorporates anti-inflammatory meals and
excludes pro-inflammatory foods has been proven to benefit many of the most fatal conditions.
An article on WebMD featured several experts discussing the advantages of the antiinflammatory diet and what comprises it (Doheny). Diets with a strong anti-inflammatory focus,
like the Mediterranean diet, are associated with reduced cardiovascular disease risk (MartinezGonzalez and Bes-Rastrollo). A review of several studies also indicated protective effects against
cancer and Alzheimers (Verberne et al.; Sofi et al.). It is very likely that a contributing source of
these protective effects is ECS enhancement.
Any diet can be modified depending on an individuals preferences. All anti-inflammatory
plans include lots of fruits, vegetables, and Omega-3 rich foods like walnuts, flaxseed, fish, and
eggs. Whole grains, nuts, and seeds are also prominent, as is extra-virgin olive oil. Many meals
are well-spiced with anti-inflammatory herbs or blends like ginger and curry. Refined and
23

processed foods are avoided, including most vegetable oils and white bread. Red meat and whole
dairy products are minimized as well. These cuts help reduce saturated fat, trans fat, and blood
sugar levels. A HuffingtonPost article listed the top pro-inflammatory foods as:
Trans fats
Sugar
White bread
Cheeseburgers
Alcohol
Omega-6 Fatty Acids
Milk (especially whole and 2%)
Monosodium glutamate
Gluten
(Klein)
The effects of wheat on inflammation and digestion are controversial. People with celiac disease
cannot tolerate gluten (the protein in wheat) at all, but there is also a subsection of the population
that is moderately gluten intolerant. Anyone trying to actively fight inflammation should at least
temporarily remove wheat to see what happens. There are many high quality, nutritious glutenfree grains like brown rice, amaranth, quinoa, buckwheat, and millet. Some forms of wheat are
reportedly less inflammatory, such as sprouted varieties like Ezekial bread or ancient breeds like
spelt.
While the negative health impact of whole wheat is seriously debated, the harm of refined
grains is generally agreed upon. White grains, including gluten-free options such as white rice,
are stripped of beneficial nutrients. Furthermore, the body processes them like sugar, so refined
grains can cause spikes in blood sugar and inflammation. A 2010 study found that refined grain
consumption was associated with higher inflammatory markers, whereas whole grain
consumption did not have this relationship (Masters et al.).
An article on Prevention.com listed some of the best anti-inflammatory foods:

24

Raisins
Salmon
Basil
Ginger
Sweet potatoes
Cherries
Kale
Walnuts

 Tea
(Chia)
A 2004 study determined that diet significantly affects inflammatory markers in the body
(Lopez-Garcia et al.). One group of women consumed a traditional Western diet with high
intakes of red and processed meat, desserts, fries, and refined grains. The other group on a
prudent diet primarily consumed fruits, vegetables, whole grains, fish, poultry, and legumes.
The Western diet was positively correlated with numerous inflammatory markers while the
prudent diet was inversely correlated with them.
Organic foods can contribute to a healthy ECS. A variety of pesticides may inhibit
FAAH, the enzyme that degrades anandamide. Although inhibiting FAAH is a positive effect of
many compounds, pesticides seemingly exert too strong of an inhibitory influence (Quistad,
Sparks, and Casida; Carr, Borazjani, and Ross.). A comprehensive 2014 study determined that
1organic foods are generally more nutritious than conventionally grown crops, containing up to
69% higher levels of antioxidants as well as lower levels of the toxic metal cadmium (Baraski
et al.). In general, the evidence and even common intuition support the value of eating organic
foods.
Extra-virgin olive oil, mentioned earlier as a component of the anti-inflammatory diet,
interacts with the ECS. One study showed olive oil and its phenolic extracts upregulated CB1
receptors in human colon cancer cells, and this effect may be a novel therapeutic mechanism for
treating or preventing colon cancer (Di Francesco et al.).
Evidence strongly suggests that chronic alcohol consumption is not good for the ECS. A
1998 study determined that chronic ethanol exposure downregulated CB1 receptors in mice
(Basavarajappa, Cooper, and Hungund). A later study found ethanol downregulated CB1
receptors and impaired receptor signaling, but increased anandamide levels (Vinod et al.). Longterm exposure to alcohol is associated with neurological damage, which the ECS must work to
slow down. Therefore, avoiding excessive alcohol consumption is the safest way to ensure
optimal endocannabinoid signaling.

Essential Fatty Acids

The foundation of the ECS is essential fatty acids (EFAs). Both Omega-6 and Omega-3 EFAs
are required for the production of endocannabinoids and cannabinoid receptors. It is necessary to
consume both types of EFAs because the body cannot synthesize them.
In addition to requiring adequate amounts of Omega-6 and Omega-3, maintaining the
proper balance, or ratio, is critical. EFAs are metabolized through the same pathways, so eating
too much Omega-6 or Omega-3 will inhibit proper metabolism of the other fat. While
overconsuming Omega-3 can be problematic, the vast majority of people suffer from an excess
of Omega-6. This is because Omega-6 is so readily available, primarily in vegetable oils derived
25

from canola, corn, cottonseed, peanut, safflower, and sunflower seeds. These oils are found in a
wide variety of packaged and processed foods. Unfortunately, sources of Omega-3 are relatively
lacking in society, which further impairs EFA balance. Most people get some quality Omega-3
through eggs and fish, but it is often not enough to compensate for the high Omega-6 intake.
Omega-3 fatty acids are generally anti-inflammatory, whereas Omega-6 fatty acids are
proinflammatory (Covington). The early human diet had a dietary ratio of 1:1 Omega-6 to
Omega-3, whereas the modern diets ratio is 10:1 or higher. Omega-3 consumption has been
proven to protect against cardiovascular damage, and large doses reduce high triglyceride levels
and improve rheumatoid arthritis symptoms. An anti-inflammatory diet alone alleviates
rheumatoid arthritis, but adding Omega-3-rich fish oil significantly enhances those benefits
(Adam et al.). Omega-3 supplementation can also, to a lesser extent, help people who eat a
proinflammatory Western Diet.
Omega-6 to Omega-3 ratios exert protective effects at ratios as high as 5:1, but between
2:1 and 3:1 is more powerful (Simopoulos). When dealing with a serious disease, aiming for
between 1:1 and 2:1 seems ideal. Ratios of 10:1 or higher promote the development of
cardiovascular diseases, cancers, autoimmune disorders, and inflammatory diseases.
Given that Omega-3 acids and endocannabinoids share similar benefits, it is very possible
that enhanced endocannabinoid production or function is the healing mechanism behind
increased EFA consumption. While endocannabinoids are also produced from Omega-6, an
imbalance of it promotes inflammation. Most people need to work on getting more Omega-3 into
their diets rather than Omega-6, but if large quantities of the former are being taken, the latters
consumption will need to increase as well.
The importance of Omega-3 to the ECS was conveyed in a 2011 study titled Nutritional
Omega-3 Deficiency Abolishes Endocannabinoid-Mediated Neuronal Functions (Lafourcade et
al.). Using mice, the study found that a deficiency in Omega-3 caused presynaptic CB1 receptors
to uncouple from their effector G proteins, essentially disabling them. This dietary-induced
impairment of CB1 function adversely affected emotional behavior. Increased Omega-3
consumption has been linked to upregulation of CB1 and CB2 receptors, as well as increased
levels of endocannabinoid synthesis enzymes (Hutchins-Wiese et al.). However, it is important
to maintain a balanced ratio of Omega-6 and Omega-3, or the latters supplementation may not
be as therapeutically effective. Other negative dietary habits could also impair proper
metabolism of fatty acids.
Foods like flax, hemp, and chia seeds, along with walnuts, are excellent vegetarian
sources of Omega-3. The form of Omega-3 in these products is alpha-linolenic acid, which must
be converted into the longer-chain Omega-3 compounds known as eicosapentaenoic acid (EPA)
and docosahexaenoic acid (DHA). Due to the relatively low efficiency of this conversion, it is
important to directly consume EPA and DHA as well. These acids are almost only found in
animal sources like fish, eggs, and meat. Fish oil is an easy way for anyone to adequately
supplement their Omega-3 intake, as long as it is properly manufactured and distilled to
eliminate heavy metals. There are also vegetarian algae-based products which provide DHA.
26

Supplementation with algal DHA is likely as effective as fish-based DHA, as it can reduce serum
triglycerides and improve cholesterol (Bernstein et al.). However, more research is needed on
this particular supplement.
Probiotics
The body contains an enormous quantity of microorganisms that comprise the human
microbiome. Under normal conditions, these bacteria assist the body and contribute to general
health. There are an estimated 10 times more microbes than human cells in our bodies (Zimmer).
The gastrointestinal system hosts many of these positive bacteria, where they directly support the
immune system. In fact, 70% of the immune system resides in gut-associated lymphoid tissue
(Vighi et al.). Humans can take probiotics, or good bacteria, to improve their digestive and
immune health. Studies have shown probiotic ingestion could potentially treat diarrhea-related
conditions, inflammatory bowel disease, and autism (Culligan, Hill, and Sleator; Hsiao et al.).
Probiotics reduce inflammation, and some strains can even fight cancer, such as the Acetobacter
indonesiensis and Acetobacter syzygii bacteria found in Iranian yogurt (Haghshenas et al.).
The anti-inflammatory and immune-supporting properties of probiotics suggest the
bacteria would enhance the ECS. There are also direct studies linking probiotic consumption to
improved cannabinoid signaling. Interestingly, depending on the situation, probiotics can either
upregulate or downregulate cannabinoid receptors to optimally benefit their host. This
characteristic exemplifies the homeostatic-regulatory nature of probiotics, and bolsters their
connection to the ECS.
Human intestinal cells incubated with the common probiotic Lactobacillus acidophilus
have increased CB2 receptor expression (Rousseaux et al.). Incredibly, probiotic administration
confers analgesic effects in the colon by acting through a CB2-dependent mechanism.
Probiotic treatment was shown to upregulate CB1 receptors in a species of fish (Palermo
et al.). However, in obese mice with elevated levels of CB1 receptors in the colon, prebiotic
administration (which increases intestinal probiotic count by acting as food) decreased
CB1density and anandamide production (Muccioli et al.). This change was accompanied by a
reduction in fat mass. The ECS interacts with intestinal bacteria to control gut permeability and
the creation of new fat cells. As demonstrated, probiotics seem to have an innate intelligence that
enables them to correct ECS imbalances.
Probiotics can be acquired from many sources, and should be consumed through various
methods for optimal gut colonization. Supplements are an excellent way to quickly get a lot of
good bacteria in you. Quality supplements should be designed to survive digestion and contain at
least 10 billion colony forming units. More effective supplements have higher CFU counts and a
greater variety of bacteria strains. In addition to taking a probiotic supplement, you should
consume fermented foods and beverages. Yogurt, sauerkraut, tempeh, kimchi, and some forms of
coleslaw deliver viable bacteria. Kombucha, kefir milk, and speciality probiotic drinks work as
well.
27

You can also protect your microbiome by avoiding harmful foods. The anti-inflammatory
diet described earlier naturally enhances your gut microorganisms. Some aspects of the Western
diet, such as a high intake of animal-derived saturated fat, are linked to the expansion of
pathological bacteria (Devkota et al.).
An amazing resource that answers the top questions about probiotics can be found here:
http://whole9life.com/2012/04/probiotics-101.
Herbs and Foods with Endocannabinoid System Activity
There are many herbs and foods that affect the ECS. An excellent, comprehensive article titled
Care and Feeding of the Endocannabinoid System: A Systematic Review of Potential Clinical
Interventions that Upreguate the Endocannabinoid System summarizes these effects
(McPartland, Guy, and Di Marzo). This article was also very useful as a guide and source of
ideas for other enhancement techniques.

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Copal incense from the Protium plant species has a terpene with high affinity for CB1 and
CB2
Thujone, a constituent of wormwood (used in absinthe), has weak binding affinity for
CB1
The Vitamin E derivative alpha-tocopheryl phosphate modulates synaptic transmission in
rodent hippocampi, possibly through an indirect CB1-mediated mechanism
The flavonoids biochanin A (from red clover), genistein (from soybean), and kaempferol
(from true tea, Camelia sinensis), inhibit FAAH and thus indirectly increase anandamide.
EGCG, the compound most responsible for tea's health benefits, has a low binding
affinity for CB1
Curcumin from the popular Indian herb turmeric elevates endocannabinoid levels and
brain nerve growth factor in certain brain regions, likely through a CB1-dependent
mechanism. However, like Vitamin E, curcumin has not been definitively shown to bind
with CB1, indicating an indirect effect on the receptor
Cocoa powder may contain small amounts of anandamide
Semiplenamide A, an anadamide-like fatty acid from the blue-green algae Lyngbya
semiplena has a low binding affinity for CB1 and inhibits anandamide breakdown.
Another blue-green algae, Lyngbya majuscula, produces a fatty acid called grenadamide
with low affinity for CB1 receptors. Other forms of algae like Chlorophyta, Laminaria
angustata, and Mycale micraanthoxea contain many endocannabinoid-like compounds
The Echinacea genus, especially the species purpurea, has constituents that activate CB2
receptors with relatively high affinity. The compounds also inhibit anandamide uptake
and thus increase its levels. Interestingly, some constituents are weak CB1 antagonists

Common black pepper contains the terpenoid beta-caryophyllene, which has a strong
binding affinity for the CB2 receptor. Beta-caryophyllene has been proven to exert antiinflammatory and analgesic activity via CB2
The medicinal herb Ruta graveolens contains rutamarin, which has some affinity for CB2
An unidentified compound in the superfruit noni has weak affinity for CB2
Fish are useful for enhancing the ECS because of their long-chain Omega-3 fatty acids.
Some types of shellfish contain anandamide and/or 2-AG, including the mussel Mytilus
galloprovincialis, the clam Tapes dicussatus, the oyster Crassosterea sp., the sea urchin
Paracentrotus lividus, and the sea squirt Ciona intestinalis

Consuming a variety of these foods can naturally enhance ECS activity. Depending on ones
health goals, focusing on foods high in CB1 or CB2 agonists may optimize results. For example,
combining black pepper and Echinacea purpurea could potentially be a very effective cannabisfree method of stimulating CB2 and reducing inflammation.
Stress and Depression
The mind is intimately connected to the body. It has been proven that mindset, attitude, and
thoughts have potent effects on many physiological functions. Therefore, a critical part of being
healthy is keeping stress levels low and thinking positively. The ECS plays a major role in the
stress response. It maintains hypothalamic-pituitary-adrenal (HPA) axis homeostasis through
multiple mechanisms, including glucocorticoid regulation (Riebe and Wotjak). Endocannabinoid
signaling both activates and terminates the HPA axis response to acute and chronic stress (Hill et
al.). During stress, endocannabinoids are recruited by stress hormones to modulate various
cognitive functions. They are also involved in physiological and behavioral habituation processes
related to chronic stress. If long-term stress depletes the ECS through overrecruitment of
endocannabinoids, that would explain its propensity to aggravate various diseases.
As described in the previous Essential Fatty Acids section, high Omega-6 to Omega-3
ratios increase the risk for inflammatory diseases. They may also enhance the risk of depression.
Depressive symptoms exacerbate the inflammation caused by high ratios; as depression
increases, inflammatory markers rise as well (Kiecolt-Glaser et al.). Epidemiological and other
studies suggest that Omega-3 deficiency may directly cause some types of depression (KiecoltGlaser). On average, depressed patients have lower plasma levels of Omega-3 than nondepressed patients, and Omega-3 supplementation can produce therapeutic benefits. The ability
of Omega-3 to reduce inflammation, potentially through its fueling of the ECS, may effectively
treat depression.
Omega-3 supplementation is one of the most powerful methods for reducing depression
and generally enhancing endocannabinoid activity. However, using other techniques to alleviate
stress and depression can further lighten the workload of your ECS. Some practices that mitigate

29

stress, like meditation and exercise, are covered more extensively in later sections. Below are a
few science-backed stress-relief techniques that work:

Aromatherapy is an effective stress management method for students (Seo)

Certain kinds of music may trigger stress-reducing effects, but the variation between
individuals is high (Cervellin and Lippi). It is important for people to find the music that
is most relaxing for them
Laughter reduces stress in postpartum women (Shin, Ryu, and Song). These clinical
results support the general notion that laughter is therapeutically beneficial
A double-blind, placebo-controlled study demonstrated six weeks of black tea
consumption reduces the stress hormone cortisol and leads to greater relaxation (Steptoe
et al.)
Touch massage significantly decreases heart rate, cortisol, and insulin levels, indicating a
reduced stress response (Lindgren et al.)
Midday naps after sleep restriction reduce stress levels and alleviate other problems
caused by a lack of sleep (Faraut et al.)
Art therapy may be an effective add-on treatment to tone down the stress component of
many conditions (Mimica and Kalini; Chapman et al.; Avrahami)
Relaxing activities like walking and reading reduce mental and emotional stress (Jin)

An article on Prevention.com listed some of the top stress-fighting foods:

Asparagus
Avocados
Berries
Cashews
Chamomile tea and green tea
Dark chocolate
Garlic
Grass-fed beef
Oatmeal
Oranges
Oysters
Walnuts
(Glassman)

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Yoga and Meditation

The practices of yoga and meditation have been used for thousands of years. Meditation is a
central tenet of several Eastern religions, as it is believed to be essential for attaining
enlightenment. Throughout history, meditation has been reported to have significant health
benefits. It is only now that science is catching up.
Breathing is a major component of meditation, and deep breathing alone can reduce
cortisol levels (Cea, Gonzalez-Pinto, and Cabo). Chronically high cortisol levels keep blood
sugar levels high by releasing more glucose and inhibiting insulin production (Aronson). Over
time, cortisol suppresses the immune system, and probably the ECS as well given its integral
connection to immune function.
Meditation-like practices known as mindfulness-based stress reduction and mindfulnessbased cognitive therapy, along with Zen meditation itself, have broad-spectrum antidepressant
and antianxiety effects (Marchand). They also contribute to general psychological health and
improved stress management. Incredibly, mindfulness meditation can positively change gene
expression to reduce inflammation, potentially combating chronic inflammatory disorders
(Kaliman et al.). Over time, meditation directly modifies physical brain structures. For example,
it can reduce the size of the amygdala, which is associated with fear, and increase cortical
thickness in brain regions associated with attention and sensory processing (Taren, Creswell, and
Gianaros; Lazar et al.). Meditation may even offset age-related cortical thinning. These physical
cognitive modifications augment stress resilience and may reduce symptoms of other disorders.
Yoga breathing, known as pranayama, synergistically enhances the effects of meditation
(Brown and Gerbarg). Clinical evidence supports therapeutic effectiveness of yoga breathing for
depression, anxiety, and post-traumatic stress disorder. The yoga practice itself is a combination
of meditation and exercise, employing a variety of stretches that range from relaxing to
incredibly challenging. Yogic exercises have been shown to reduce life stress and blood glucose
levels (Kim). By combining yoga with traditional meditation, truly immense benefits can be
realized.
The scope of meditative and yogic practice is very extensive. Over 200 free guides are
located at http://www.yogaoutlet.com/guides. One such guide,
http://www.yogaoutlet.com/guides/how-to-practice-mindfulness-meditation, efficiently describes
how to do mindfulness meditation. Below is a summary of this guide:
1. Sit in a comfortable position with your head, neck, and spine in a straight line. There are
many suitable positions for meditation.
2. Close your eyes and focus on your breathing. Regulate it at first, inhaling through your
nose for five seconds, and then exhaling through your nose for five seconds.
3. Breathe naturally. Continue focusing on your breath. When your mind naturally wanders,
gently return to your focus.

31

4. Do this for between 10 and 30 minutes. It really is that simple, and maintaining
concentration gets easier over time.

Given the proven ability of meditation to modify the nervous system, it probably also directly
influences the ECS. While no formal research has made this connection, the established
therapeutic benefits strongly suggests some interaction between meditation and the ECS.
Acupuncture and Massage
Various types of mind-body medicine have been used since antiquity to treat specific conditions
and improve overall health. Although benefits have been reported throughout this period, the
mechanisms underlying them remained elusive. The ECS may just be the primary therapeutic
system affected by acupuncture and massage techniques.
Acupuncture is the practice of using needles to stimulate healing in the body. A specific
form called electro-acupuncture (EA) has been proven to influence the ECS. EA is like regular
acupuncture, except electrodes are attached to the needles after insertion to provide sustained
stimulation (Dharmananda). Using electrodes simplifies treatment for the practitioner, improves
control, and provides the ability to increase strength for serious conditions.
EA reduces thermal and mechanically-related pain through a CB2 receptor-mediated
mechanism (L. Chen et al.). The therapy is associated with an increase in anandamide in the
applied area. It also upregulates CB2 receptors in inflamed skin tissue, specifically in
keratinocytes (the primary cell type in the epidermis) and inflammatory immune-related cells
(Zhang et al.).
While the analgesic effects of EA have been attributed to CB2 receptors, there is evidence
the therapy also works through CB1 receptors to confer neuroprotection. A 2011 study showed
EA pretreatment activates CB1 and protects against ischemic damage via an anti-apoptotic
mechanism (Wang et al.).
Although there are no current studies directly linking regular, non-electro acupuncture to
enhancement of the ECS, it is quite possible a relationship exists. A 2012 case report described a
woman with chronic neuropathic pain from multiple sclerosis who used acupuncture and the
endocannabinoid-like molecule palmitoylethanolamide (PEA) to improve her condition (Kopsky
and Hesselink). Acupuncture alone was partly and temporarily effective in reducing pain, but
adding PEA significantly enhanced pain relief and lessened the amount of required acupuncture
sessions. Both acupuncture and PEA influenced activated glial cells.
Osteopathic manipulative treatment (OMT) is a hands-on practice used by osteopathic
physicians to diagnose, treat, and prevent illness or injury (Osteopathic). A double-blind,
controlled trial found OMT increased anandamide levels by 168%, decreased
oleoylethanolamide levels by 27%, and did not change 2-AG levels (McPartland et al.). The
authors suggested that the ECS mediates the therapeutic effects of OMT.
32

Given the similarities between other forms of massage and OMT, they could also convey
benefits mediated through the ECS. Massage therapy reduces stress levels in cancer patients, and
these effects can extend to anyone (Keir; Taylor et al.). Swedish massage therapy lowers blood
pressure, heart rate, and inflammatory markers in hypertensive women (Supaat et al.); chair
massage alleviates anxiety in individuals withdrawing from drugs (Black et al.); shiatsu massage
reduces pain in burn patients (Ardabili et al.). Theoretically, it makes sense that at least part of
this effectiveness stems from enhanced endocannabinoid activity.

Exercise
Organisms have been constantly moving since the inception of life. Therefore, it is intuitively
reasonable that movement supports overall wellness. Since the ECS is closely connected to
general wellness, the influence of exercise on the system is expected. A 2003 study reported that
exercise activates the ECS (Sparling et al.). Running or cycling for 50 minutes was associated
with increased endocannabinoid levels, which could contribute to exercise-induced analgesia and
runners high. A later 2012 study showed 60 minutes of intense cycling increased anandamide,
but not 2-AG, levels (Heyman et al.).
Exercise has been linked to improvements in the brain that lead to better cognition and
antidepressant effects. A key protein thought to explain these exercise-induced cognitive
improvements is brain-derived neurotrophic factor (BDNF). This compound increases
significantly after strenuous exercise (Reynolds). The aforementioned 2012 study posited that
anandamide is a middleman in the exercise-BDNF relationship; exercise increase anandamide,
which increases BDNF to exert pro-cognitive effects (Heyman et al.).
Several types of physical activities help upregulate endocannabinoid signaling. Both high
and low-altitude hiking cause increased anandamide production (Feuerecker et al.). The best
exercises for ECS enhancement are medium or high-intensity voluntary activities (McPartland,
Guy, and Di Marzo). Ideally, you should exercise at this level for at least 30 minutes 5 days per
week. Very high or very low intensity exercises do not significantly impact anandamide levels.
The increase in anandamide could explain many proven benefits of exercise. These
benefits include reduced stress, anxiety, and depression, along with improved mood (Exercise
and Stress). Furthermore, moderate intensity exercises reduce risk for cardiovascular diseases
and cancer (Woodward). Not surprisingly, such exercises also burn intra-abdominal fat.
Reducing such fat is important and effective for protecting against heart disease, cancer, and
diabetes (McTiernan et al.).
The National Cancer Institute states that exercise can:
Help control weight
Maintain healthy bones, muscles, and joints
Reduce the risk of high blood pressure and diabetes
Promote psychological well-being
33

 Reduce the risk of death from heart disease

Reduce the risk of certain cancers
Reduce the risk of premature death
(Physical Activity)

Cannabis
The cannabis plant produces phytocannabinoids which are very similar in structure to the
endocannabinoids made by our bodies. Assessing the consistent effects of cannabis on health or
the ECS is difficult because of the plants complexity. All strains of cannabis contain THC,
CBD, and hundreds of other cannabinoids, terpenoids, flavonoids, and other constituents. Many
of these compounds interact directly or indirectly with the ECS. For example, THC activates CB1
and CB2 receptors, and CBD increases anandamide levels. The utility of cannabis to enhance the
ECS may include direct substitution of endocannabinoid agonist functions and other, less direct
supportive roles.
Some isolated cannabinoids have been studied for their effects on the ECS. Short-term
use of THC is linked to upregulation of CB1 receptors in certain brain regions like the cerebellum
and hippocampus (Romero et al.; Zhuang et al.). There is also a bidirectional potentiation
relationship between THC and endocannabinoids, with THC being able to enhance analgesic
effects of endocannabinoids and vice versa (Suplita et al.). However, chronic THC consumption
is associated with decreased CB1 density and impaired cannabinoid signaling (Romero et al.;
Breivogel et al.; Suplita et al.). The rate and magnitude of CB1 downregulation varies by brain
region and in some places is unchanged. Levels of endocannabinoids like anandamide and 2-AG
are relatively unaffected by long-term ingestion of THC, although anandamide increases can
occur in the limbic forebrain (Di Marzo et al.). Indeed, THC administration stimulates the
biosynthesis of anandamide by mobilizing its precursor compound arachidonic acid (Burstein
and Hunter). Although chronic high-THC cannabis consumption causes CB1 downregulation,
levels of the receptor can be reversed to normal levels with just a few weeks of cannabis
abstinence (Hirvonen et al.).
The effects of chronic high-CBD cannabis consumption are unknown, but likely carry far
less risk than high-THC cannabis. CBD is non-psychoactive and does not cause impairments
(short-term memory problems, decrease in motor skills, etc.) attributed to THC, although
exceptionally large doses (hundreds to thousands of milligrams) can increase some impairment
metrics associated with low-dose THC (Hayakawa et al.). High-dose CBD combined with lowdose THC upregulates CB1 expression in the hippocampus and hypothalamus. One study
reported that THC impaired learning without affecting neurogenesis (the creation of new brain
cells), while CBD did not impair learning and increased neurogenesis through a CB1-dependent
mechanism (Wolf et al.). A 2013 study showed CBD conferred anxiolytic effects in chronically
stressed mice through enhanced neurogenesis (Campos et al.). Some of these benefits may stem
34

from CBDs ability to increase anandamide levels by inhibiting the compounds uptake and
breakdown (Bisogno et al.; De Petrocellis et al.). Enhanced anandamide signaling is thought to
account for CBDs therapeutic effectiveness against schizophrenia, so it may explain other
healing effects as well (Leweke et al.).
Other cannabinoids increase anandamide via uptake inhibition, including cannabigerol
(CBG) and cannabichromene (CBC), which are actually more potent in this respect than CBD
(De Petrocellis et al.). A variety of other neutral (decarboxylated, heated) and acid (raw,
unheated) cannabinoids, including cannabigevarin (CBGV), tetrahydrocannabidivarin (THCV),
tetrahydrocannabinolic acid (THCA), and cannabidiolic acid (CBDA), exert a range of complex
effects on the ECS. The complexity is increased given that humans normally consume wholeplant extracts with all the most common cannabinoids present in varying quantities. Thankfully,
such extracts have been proven to enhance the ECS and are usually more potent than isolated
cannabinoids, including when it comes to inhibiting anandamide uptake (De Petrocellis et al.).
Interestingly, cannabis extracts, but not isolated cannabinoids, can inhibit monoacylglyceride
lipase (MAGL), the enzyme that degrades 2-AG. In this way, whole-plant extracts can
effectively increase both anandamide and 2-AG concentrations.
Evidence suggests that long-term, continuous consumption of high-THC cannabis is safe
but not optimal for the ECSs functioning. However, regular intake of therapeutic cannabis
extracts with moderate amounts of THC and significant amounts of other non-psychoactive
cannabinoids can probably benefit most people. What works best for each individual varies
widely, although there are useful starting guidelines. For general health, cannabis extracts with
very high levels of CBD are ideal for maintenance and well-being. When it comes to treating
diseases, the ratio of THC to CBD is critical, but precision is less important for maintaining
overall health.
There is virtually no research on adequate maintenance doses and THC:CBD ratios for
healthy people, but 10 to 50 milligrams daily of whole-plant high-CBD extract (which contains
other cannabinoid and therapeutic constituents as well) is probably a good level to aim for. Some
evidence shows that even very low levels of THC, including just a few milligrams, confers
protective benefits (Fishbein-Kaminietsky, Gafni, and Sarne; Waldman et al.). It is likely that
CBD also provides these benefits at low doses, but more research is needed.
The best cannabis extracts are derived from organically-grown material and processed
with organic food-grade ethanol. They are tested with laboratory equipment to confirm
cannabinoid content and safety metrics, including absence of pesticide and solvent residues.
Tinctures and oils are the most effective and efficient extracts. Alcohol-based tinctures have been
used for thousands of years, and many such tinctures featuring non-cannabis herbs are popular in
health stores. For people who want more potency and absolutely no alcohol, full-strength oils are
better. Both cannabis oil and cannabis tincture should ideally be consumed alongside coconut oil,
olive oil, hemp seed oil, or other healthy oils to increase absorption and bioavailability.
Consuming extracts under the tongue, rather than normally eating them or swallowing capsules,
also improves absorption. Detailed information on the rates of absorption between different
35

intake methods and cannabinoids is found at

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689518 (Huestis).
Project CBD, a non-profit educational service, has provided a useful guide on how to
properly dose. You can find this resource here: http://www.projectcbd.org/medicine-2/dosage.
For convenience, the key steps are shown below:
1. Decide how you want to take cannabis. Dosed cannabis medicine infused with CBD-rich
oil extracts is available in sublingual sprays, capsules, edibles, topicals, tinctures and
other products.
2. Find your ratio. Cannabis products have varying amounts of CBD and THC. A high CBD
strain or product (with little THC) is not necessarily superior to a strain or product with a
more balanced CBD:THC ratio. Find the proper combination for you.
3. Begin with a low doseespecially if you have little or no experience with cannabis.
4. Take a few small doses over the course of the day rather than one big dose.
5. Use the same dose and ratio for several days. Observe the effects and consider if you
need to adjust the ratio or amount.
6. Dont overdo it. Often with cannabinoid therapeutics, less is more. Cannabinoid
compounds have biphasic properties. This means that higher doses of CBD may not be as
effective as low or moderate doses. Also, too much THCwhile not lethalcan increase
anxiety and mood disorders.
7. Consider the condition youre treating. For anxiety, depression, spasms, and pediatric
seizure disorders, you may do better with a moderate dose of a CBD-dominant remedy
look for a CBD:THC ratio of more than 14:1. For cancer or pain, you may need more
THC, for instance, a 1:1 ratio.
An excellent post from United Patients Group, a premier organization assisting cannabis patients
and caregivers, has provided detailed examples of cannabis dosing here:
http://www.unitedpatientsgroup.com/blog/2013/11/26/what-is-a-cannabis-dose-by-aunt-zeldasoils/.

36

V.

Conclusion

The science of the endocannabinoid system is constantly evolving. We are always learning more
about how it maintains general health and influences disease. While there is still so much more
knowledge to discover, we know enough to justify the use of cannabis extract medicine and ECS
enhancement techniques. In time, humanity will learn new ways to empower the ECS and treat
many diseases in a far more natural way.

Top 10 Ways to Enhance Your Endocannabinoid System

1. Consume more Omega-3 fatty acids and less Omega-6 fatty acids. Therefore, increase
consumption of fish, eggs, hemp seeds, flax seeds, chia seeds, walnuts, and certain forms
of algae. Reduce consumption of cheap vegetable oils, and stick to using olive oil,
coconut oil, hemp seed oil, avocado oil, or walnut oil.
2. Eat primarily a plant-based diet with as much organic content as possible. Avoid
inflammatory foods like refined grains, sugar, whole-fat dairy, processed meat, and
hydrogenated vegetable oils. Avoid artificial ingredients.
3. Do at least 15 minutes of meditation every day.
4. Do at least 15 minutes of exercise every day.
5. Make time to reduce your stress levels by reading, listening to music, or walking.
6. Take a high-quality probiotic supplement and eat probiotic foods like yogurt, sauerkraut,
kimchi, and fermented vegetables.
7. Do not excessively consume alcohol and antibiotics.
8. Get some form of acupuncture, massage, or osteopathic manipulation at least a couple
times a year. In general, the more the better.
9. Do not consume excessive amounts of very high-THC cannabis, especially through the
smoking route.

37

10. Consume moderate amounts of high-CBD cannabis extracts in the forms of tinctures or
oils. Ideal dosage is highly individualized, but between 10 and 50 milligrams a day
should benefit most people.

38

Citations & References

Adam, O, C Beringer, T Kless, C Lemmen, A Adam, M Wiseman, et al. Anti-Inflammatory
Effects of a Low Arachidonic Acid Diet and Fish Oil in Patients With Rheumatoid Arthritis.
Rheumatology International 23.1 (2003): 27-36. Web.
Ardabili, FM, S Purhajari, T Najafi Ghezeljeh, and H Haghani. The Effect of Shiatsu Massage
on Pain Reduction in Burn Patients. World Journal of Plastic Surgery 3.2 (2014): 115-118.
Print.
Aronson, Dina. Cortisol Its Role in Stress, Inflammation, and Indications for Diet Therapy.
TodaysDietician.com. Great Valley Publishing Company, Inc., November 2009. Web. 17 Jan.
2015. <http://www.todaysdietitian.com/newarchives/111609p38.shtml>.
Avrahami, D. Visual Art Therapys Unique Contribution in the Treatment of Post-Traumatic
Stress Disorders. Journal of Trauma and Dissociation 6.4 (2005): 5-38. Print.
Baraski, M, D Srednicka-Tober, N Volakakis, C Seal, R Sanderson, et al. Higher Antioxidant
and Lower Cadmium Concentrations and Lower Incidence of Pesticide Residues in Organically
Grown Crops: A Systematic Literature Review and Meta-Analyses. The British Journal of
Nutrition 112.5 (2014): 794-811. Print.
Basavarajappa BS, TB Cooper, and BL Hungund. Chronic Ethanol Administration DownRegulates Cannabinoid Receptors in Mouse Brain Synaptic Plasma Membrane. Brain Research
793.1-2 (1998): 212-218. Print.
Bermdez-Silva Bermdez-Silva FJ, J Surez Prez, A Nadal, and F Rodrguez De Fonseca.
The Role of the Pancreatic Endocannabinoid System in Glucose Metabolism. Best Practice &
Research: Clinical Endocrinology & Metabolism 23.1 (2009): 87-102. Print.
Bernstein, AM, EL Ding, WC Willett, and EB Rimm. A Meta-Analysis Shows That
Docosahexaenoic Acid From Algal Oil Reduces Serum Triglycerides and Increases HDLCholesterol and LDL-Cholesterol in Persons Without Coronary Heart Disease. The Journal of
Nutrition 142.1 (2012): 99-104. Print.
Bisogno, T, L Hanus, L De Petrocellis, S Tchilibon, DE Ponde, et al. Molecular Targets for
Cannabidiol and its Synthetic Analogues: Effect on Vanilloid VR1 Receptors and on the Cellular
Uptake and Enzymatic Hydrolysis of Anandamide. British Journal of Pharmacology 134.4
(2001): 845-852. Print.

39

Black, S, K Jacques, A Webber, K Spurr, E Carey, et al. Chair Massage for Treating Anxiety in
Patients Withdrawing from Psychoactive Drugs. Journal of Alternative and Complementary
Medicine 16.9 (2010): 979-987. Print.
Blake, Dr, P Robson, M Ho, RW Jubb, and CS McCabe. Preliminary Assessment of the
Efficacy, Tolerability, and Safety of a Cannabis-Based Medicine (Sativex) in the Treatment of
Pain Caused by Rheumatoid Arthritis. Rheumatology (Oxford) 45.1 (2006): 50-52. Print.
Breivogel, CS, SR Childers, SA Deadwyler, RE Hampson, LJ Vogt, et al. Chronic Delta9Tetrahydrocannabinol Treatment Produces a Time-Dependent Loss of Cannabinoid Receptors
and Cannabinoid Receptor-Activated G Proteins in Rat Brain. Journal of Neurochemistry 73.6
(1999): 2447-2459. Print.
Brown, AJ. Novel Cannabinoid Receptors. British Journal of Pharmacology 152.5 (2007):
567-575. Web.
Brown, RP, and PL Gerbarg. Yoga Breathing, Meditation, and Longevity. Annals of the New
York Academy of Sciences 1172 (2009): 54-62. Print.
Burstein, Sumner. The Elmiric Acids: Biologically Active Anandamide Analogs.
Neuropharmacology 55.8 (2007): 1259-1264. Print.
Burstein, SH and SA Hunter. Stimulation of Anandamide Biosynthesis in N-18TG2
Neuroblastoma Cells by Delta 9-Tetrahydrocannabinol (THC). Biochemical Pharmacology 49.6
(1995): 855-858. Print.
Caffarel, Mara M, Clara Andradas, Emilia Mira, Eduardo Prez-Gmez, Camilla Cerutti, et al.
Cannabinoids Reduce ErbB2-Driven Breast Cancer Through Akt Inhibition. Molecular Cancer
9 (2010): 196. Web.
Campos, Alline C., Zaira Ortega, Javier Palazuelos, Manoela V. Fogaa, Daniele C. Aguiar.
The Anxiolytic Effect of Cannabidiol on Chronically Stressed Mice Depends on Hippocampal
Neurogenesis: Involvement of the Endocannabinoid System. The International Journal of
Neuropsychopharmacology 16.6 (2013): 1407-1419.

Caraceni, P, A Viola, F Piscitelli, F Giannone, A Berzigotti, et al. Circulating and Hepatic

Endocannabinoids and Endocannabinoid-Related Molecules in Patients with Cirrhosis. Liver
International 30.6 (2010): 816-825. Web.

40

Carracedo, Arkaitz, Meritxell Gironella, Mar Lorente, Stephane Garcia, Manuel Guzmn, et al.
Cannabinoids Induce Apoptosis of Pancreatic Tumor Cells via Endoplasmic Reticulum StressRelated Genes. Cancer Research 66.13 (2006): 6748-6755. Print.
Carr, RL, A Borazjani, and MK Ross. Effect of Developmental Chlorpyrifos Exposure, on
Endocannabinoid Metabolizing Enzymes, in the Brain of Juvenile Rats. Toxicological Sciences
122.1 (2011): 112-120. Print.
Carter, GT, ME Abood, SK Aggarwal, and MD Weiss. Cannabis and Amyotrophic Lateral
Sclerosis: Hypothetical and Practical Applications, and a Call for Clinical Trials. The American
Journal of Hospice & Palliative Care 27.5 (2010): 347-356. Print.
Cea, Ugarte JI, A Arrillaga Gonzalez-Pinto, and OM Cabo Gonzalez. Efficacy of the Controlled
Breathing
Therapy on Stress: Biological Correlates. Preliminary Study. Revista de Enfermera 33.5
(2010): 48-54.
Print.
Cervellin, G, and G Lippi. From Music-Beat to Heart-Beat: A Journey in the Complex
Interactions Between Music, Brain, and Heart. European Journal of Internal Medicine 22.4
(2011): 371-374. Print.
Chapman, Linda, Diane Morabito, Chris Ladakakos, Herbert Schreier, and M. Margaret
Knudson. The Effectiveness of Art Therapy Interventions in Reducing Post Traumatic Stress
Disorder (PTSD) Symptoms in Pediatric Trauma Patients. Journal of the American Art Therapy
Association 18.2 (2001): 100-104. Print.

Chen, June, Isabel Matias, Tim Dinh, Ta Lu, Sonia Venezia, et al. Finding of Endocannabinoids
in Human Eye Tissues: Implications for Glaucoma. Biochemical and Biophysical Research
Communications 330.4 (2005): 1062-1067. Print.
Chen, L, J Zhang, F Li, Y Qiu, L Wang, YH Li, et al. Endogenous Anandamide and
Cannabinoid Receptor-2 Contribute to Electroacupuncture Analgesia in Rats. The Journal of
Pain 10.7 (2009): 732-739. Web.
Cheng, D, JK Low, W Logge, B Garner, and T Karl. Chronic Cannabidiol Treatment Improves
Social and Object Recognition in Double Transgenic APPswe/PS1E9 Mice.
Psychopharmacology (Berl) 231.15 (2014): 3009-3017. Print.

41

Chia, Jessica. 10 Foods That Help Fight Inflammation. Prevention.com. Rodale Inc., n.d. Web.
13 Jan. 2015. <http://www.prevention.com/food/food-remedies/10-foods-help-fightinflammation>.
Corderoy, Amy. Cannabis May Help Reverse Dementia: Study. Smh.com.au. Sydney Morning
Herald, 6 Feb. 2013. Web. 7 Jan. 2015. <http://www.smh.com.au/national/cannabis-may-helpreverse-dementia-study-20130206-2dxsk.html>.
Covington, Maggie B. Omega-3 Fatty Acids. American Family Physician 70.1 (2004): 133140.
Culligan, Eamonn P, Colin Hill, and Roy D Sleator. Probiotics and Gastrointestinal Disease:
Successes, Problems and Future Prospects. Gut Pathogens 1 (2009): 19. Web.
De Petrocellis, L, A Ligresti, AS Moriello, M Allar, T Bisogno, et al. Effects of Cannabinoids
and Cannabinoid-Enriched Cannabis Extracts on TRP Channels and Endocannabinoid Metabolic
Enzymes. British Journal of Pharmacology 163.7 (2011): 1479-1494. Print.
Devkota, Suzanne, Yunwei Wang, Mark W. Musch, Vanessa Leone, Hannah Fehlner-Peach, et
al. Dietary-Fat-Induced Taurocholic Acid Promotes Pathobiont Expansion and Colitis in Il10/
mice. Nature 487.7405 (2012): 104-108. Print.
Di Francesco, A, A Falconi, C Di Germanio, MV Micioni Di Bonaventura, A Costa, et al.
Extravirgin Olive Oil Up-Regulates CB1 Tumor Suppressor Gene in Human Colon Cancer
Cells and in Rat Colon via Epigenetic Mechanisms. The Journal of Nutritional Biochemistry
(2014): n.pag. Web.
Di Marzo, V. The Endocannabinoid System in Obesity and Type 2 Diabetes. Diabetologia 51
(2008): 1356-1367. Print.
Di Marzo, V, F Berrendero, T Bisogno, S Gonzlez, P Cavaliere, et al. Enhancement of
Anandamide Formation in the Limbic Forebrain and Reduction of Endocannabinoid Contents in
the Striatum of Delta9-Tetrahydrocannabinol-Tolerant Rats. Journal of Neurochemistry 74.4
(2000): 1627-1635. Print.
Dharmananda, Subhuti. Electro-Acupuncture. ITMOnline.org. Institute for Traditional
Medicine, n.d. Web. 22 Jan. 2015. <http://www.itmonline.org/arts/electro.htm>.
Doheny, Kathleen. Anti-Inflammatory Diet: Road to Good Health? WebMD.com. WebMD,
LLC., n.d. Web. 12 Jan. 2015. <http://www.webmd.com/food-recipes/features/antiinflammatory-diet-road-to-good-health>.
42

Exercise and Stress: Get Moving to Manage Stress. MayoClinic.org. Mayo Foundation for
Medical Education and Research, n.d. Web. 21 Jan. 2015. <http://www.mayoclinic.org/healthyliving/stress-management/in-depth/exercise-and-stress/art-20044469>.
Faraut, B, KZ Boudjeltia, M Dyzma, A Rousseau, E David, et al. Benefits of Napping and an
Extended Duration of Recovery Sleep on Alertness and Immune Cells After Acute Sleep
Restriction. Brain, Behavior, and Immunity 25.1 (2011): 16-24. Print.
Feuerecker M, D Hauer, R Toth, F Demetz, J Hlzl, et al. Effects of Exercise Stress on the
Endocannabinoid System in Humans Under Field Conditions. European Journal of Applied
Physiology 112.7 (2012): 2777-2781. Print.
Fishbein-Kaminietsky, M, M Gafni, and Y Sarne. Ultralow Doses of Cannabinoid Drugs
Protect the Mouse Brain from Inflammation-Induced Cognitive Damage. Journal of
Neuroscience Research 92.12 (2014): 1669-1677. Print.
Glassman, Keri. 13 Foods That Reduce Stress and Depression. Prevention.com. Rodale, Inc.
n.d. Web. 18 Jan. 2015. <http://www.prevention.com/mind-body/emotional-health/13-healthyfoods-reduce-stress-and-depression>.
Guo, J, and SR Ikeda. Endocannabinoids Modulate N-Type Calcium Channels and G-ProteinCoupled Inwardly Rectifying Potassium Channels via CB1 Receptors Heterologously Expressed
in Mammalian Neurons. Molecular Pharmacology 65.3 (2004): 665-674. Print.
GW Pharmaceuticals Announces Physician Reports of Epidiolex Treatment Effect in Children
and Young Adults with Treatment-Resistant Epilepsy from Physician-Led Expanded Access
Treatment Program. GWPharm.com. GW Pharmaceuticals, 17 Jun. 2014. Web. 8 Jan. 2015.
<https://www.retailinvestor360.com/news/203-gw-pharmaceuticals-announces-physicianreports-of-epidiolex-treatment-effect-in-children-and-young-adults-with-treatment-resistantepilepsy-from-physician-led-expanded-access-treatment-program.html>.
Grimaldi, C, S Pisanti, C Laezza, AM Malfitano, A Santoro, et al. Anandamide Inhibits
Adhesion and Migration of Breast Cancer Cells. Experimental Cell Research 312.4 (2006):
363-373. Print.
Haghshenas, Babak, Yousef Nami, Norhafizah Abdullah, Dayang Radiah, Rozita Rosli, et al.
Anticancer Impacts of Potentially Probiotic Acetic Acid Bacteria Isolated from Traditional
Dairy Microbiota. LWT Food Science and Technology 60.2 (2015): 690-697. Print.

43

Hamtiaux, Laurie, Laurie Hansoulle, Nicolas Dauguet, Giulio G. Muccioli, Bernard Gallez, et al.
Increasing Antiproliferative Effects of Endocannabinoids in N1E-115 Neuroblastoma Cells
through Inhibition of Their Metabolism. PLoS One 6.10 (2011): n.pag. Web.
Hayakawa, K, K Mishima, M Hazekawa, K Sano, K Irie, et al. Cannabidiol Potentiates
Pharmacological Effects of Delta(9)-Tetrahydrocannabinol Via CB(1) Receptor-Dependent
Mechanism. Brain Research 1188 (2008): 157-164. Print.
Hermanson, Daniel J., and Lawrence J. Marnett. Cannabinoids, Endocannabinoids and Cancer.
Cancer Metastasis Review 30.3-4 (2011): 599-612. Print.
Heyman, E, FX Gamelin, M Goekint, F Piscitelli, B Roelands, et al. Intense Exercise Increases
Circulating Endocannabinoid and BDNF Levels in Humans Possible Implications for Reward
and Depression. Psychoneuroendocrinology 37.6 (2012): 844-851. Print.
High Blood Pressure Dangers: Hypertensions Effects on Your Body. MayoClinic.org. Mayo
Foundation for Medical Education and Research, n.d. Web. 8 Jan. 2015.
<http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-bloodpressure/art-20045868>.
Hill, MN, S Patel, P Campolongo, JG Tasker, CT Wotjak, et al. Functional Interactions
Between Stress and the Endocannabinoid System: From Synaptic Signaling to Behavioral
Output. The Journal of Neuroscience 30.45 (2010): 14980-14986. Print.
Hsiao, Elaine, Sara W. McBride, Sophia Hsien, Gil Sharon, Embriette R. Hyde, et al.
Microbiota Modulate Behavioral and Physiological Abnormalities Associated with
Neurodevelopmental Disorders. Cell 155.7 (2013): 1451-1463. Print.
Huestis, Marilyn A. Human Cannabinoid Pharmacokinetics. Chemistry & Biodiversity 4.8
(2007): 1770-1804. Print.
Hutchins-Wiese, HL, Y Li, K Hannon, and BA Watkins. Hind Limb Suspension and LongChain Omega-3 PUFA Increase mRNA Endocannabinoid System Levels in Skeletal Muscle.
The Journal of Nutritional Biochemistry 23.8 (2012): 986-993. Print.
Izzo, AA, G Aviello, S Petrosino, P Orlando, G Marsicano, et al. Increased Endocannabinoid
Levels Reduce the Development of Precancerous Lesions in the Mouse Colon. Journal of
Molecular Medicine (Berlin, Germany) 86.1 (2008): 89-98. Web.

44

Jin, P. Efficacy of Tai Chi, Brisk Walking, Meditation, and Reading in Reducing Mental and
Emotional Stress. Journal of Psychosomatic Research 36.4 (1992): 361-370. Print.
Jonsson, Kent-Olov, Sverine Vandevoorde, Didier M. Lambert, Gunnar Tiger, and Christopher
J Fowler. Effects of Homologues and Analogues of Palmitoylethanolamide Upon the
Inactivation of the Endocannabionid Anandamide. British Journal of Pharmacology 133.8
(2001): 1263-1275. Print.
Kaliman, Perla, Mara Jess lvarez-Lpez, Marta Cosn-Toms, Melissa A. Rosenkranz,
Antoine Lutz, et al. Rapid Changes in Histone Deacetylases and Inflammatory Gene Expression
in Expert Meditators. Psychoneuroendocrinology 40 (2014): 96-107. Print.
Keir, ST. Effect of Massage Therapy on Stress Levels and Quality of Life in Brain Tumor
Patients Observations from a Pilot Study. Supportive Care in Cancer 19.5 (2011): 711-715.
Print.
Kiecolt-Glaser, Janice K. Stress, Food, and Inflammation: Psychoneuroimmunology and
Nutrition at the Cutting Edge. Psychosomatic Medicine 72.4 (2010): 365-369. Print.
Kiecolt-Glaser, Janice K., Martha A. Belury, Kyle Porter, David Beversdorf, Stanley Lemeshow,
et al. Depressive Symptoms, n-6:n-3 Fatty Acids, and Inflammation in Older Adults.
Psychosomatic Medicine 69.3 (2007): 217-224. Print.
Kim, SD. Effects of Yogic Exercises on Life Stress and Blood Glucose Levels in Nursing
Students. Journal of Physical Therapy Science 26.12 (2014): 2003-2006. Print.
Klein, Sarah. Inflammatory Foods: 9 Of The Worst Picks For Inflammation.
HuffingtonPost.com. TheHuffingtonPost.com, Inc., 21 Mar. 2013. Web. 12 Jan. 2015.
<http://www.huffingtonpost.com/2013/03/21/inflammatory-foods-worstinflammation_n_2838643.html>.
Kopsky, DJ, and M Hesselink. Multimodal Stepped Care Approach with Acupuncture and
PPAR- Agonist Palmitoylethanolamide in the Treatment of a Patient with Multiple Sclerosis
and Central Neuropathic Pain. Acupuncture in Medicine 30.1 (2012): 53-55. Print.
Lafourcade, M, T Larrieu, S Mato, A Duffaud, M Sepers, et al. Nutritional Omega-3 Deficiency
Abolishes Endocannabinoid-Mediated Neuronal Functions. Nature Neuroscience 14.3 (2011):
345-350. Print.

45

Lazar, Sara W., Catherine E. Kerr, Rachel H. Wasserman, Jeremy R. Gray, Douglas N. Greve, et
al. Meditation Experience is Associated with Increased Cortical Thickness. Neuroreport 16.17
(2005): 1893-1897. Print.
Leweke, FM, D Piomelli, F Pahlisch, et al. Cannabidiol Enhances Anandamide Signaling and
Alleviates Psychotic Symptoms of Schizophrenia. Translational Psychiatry 20.2 (2012): e94.
Web.
Liang, C, MD McClean, C Marsit, B Christensen, E Peters, et al. A Population-Based CaseControl Study of Marijuana Use and Head and Neck Squamous Cell Carcinoma. Cancer
Prevention Research (Philadelphia) 2.8 (2009): 759-768. Print.
Lindgren, L, S Rundgren, O Wins, S Lehtipalo, U Wiklund, et al. Physiological Responses to
Touch Massage in Healthy Volunteers. Autonomic Neuroscience: Basic and Clinical 158.1-2
(2010): 105-110. Print.
Lopez-Garcia, E, MB Schulze, TT Fung, JB Meigs, N Rifai, et al. Major Dietary Patterns Are
Related to Plasma Concentrations of Markers of Inflammation and Endothelial Dysfunction.
The American Journal of Clinical Nutrition 80.4 (2004): 1029-1035. Print.

Maccarrone, Mauro, Tatiana Lorenzon, Monica Bari, Gerry Melino, and Alessandro FinazziAgr. "Anandamide Induces Apoptosis in Human Cells via Vanilloid Receptors." The Journal of
Biological Chemistry 275.41 (2000): 31938-31945. Print.
Mallet, C, L Daulhac, J Bonnefont, C Ledent, M Etienne, E Chapuy, et al. Endocannabinoid
and Serotonergic Systems are Needed for Acetaminophen-Induced Analgesia. Pain 139.1
(2008): 190-200. Print.
Marchand, WR. Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy,
and Zen Meditation for Depression, Anxiety, Pain, and Psychological Distress. Journal of
Psychiatric Practice 18.4 (2012): 233-252. Print.
Martinez-Gonzalez, MA, and M Bes-Rastrollo. Dietary Patterns, Mediterranean Diet, and
Cardiovascular Disease. Current Opinion in Lipidology 25.1 (2014): 20-26. Print.
Masters, RC, AD Liese, SM Haffner, LE Wagenknecht, and AJ Hanley. Whole and Refined
Grain Intakes are Related to Inflammatory Protein Concentrations in Human Plasma. The
Journal of Nutrition 140.3 (2010): 587-594. Print.
McHugh, D, SS Hu, N Rimmerman, A Juknat, Z Vogel, et al. N-Arachidonoyl Glycine, an
Abundant Endogenous Lipid, Potently Drives Directed Cellular Migration Through GPR18, the
46

Putative Abnormal Cannabidiol Receptor. BMC Neuroscience 11 (2010): n.pag. Web.

McPartland, John M, A Giuffrida, J King, E Skinner, J Scotter, et al. Cannabimimetic Effects
of Osteopathic Manipulative Treatment. The Journal of the American Osteopathic Association
105.6 (2005): 283-291. Print.
McPartland, John M, Geoffrey W. Guy, and Vincenzo Di Marzo. Care and Feeding of the
Endocannabinoid System: A Systematic Review of Potential Clinical Interventions that
Upregulate the Endocannabinoid System. PLoS One 9.3 (2014): n.pag. Web.
McPartland, John M. The Endocannabinoid System: An Osteopathic Perspective. The Journal
of the American Osteopathic Association 108.10 (2008): 586-600. Print.
McTiernan, A, B Sorensen, ML Irwin, A Morgan, Y Yasui, et al. Exercise Effect on Weight
and Body Fat in Men and Women. Obesity 15.6 (2007): 1496-1512. Print.
Mimica, N, and D Kalini. Art Therapy May be Beneficial for Reducing Stress Related
Behaviours in People with Dementia Case Report. Psychiatria Danubina 23.1 (2011): 125128. Print.
Muccioli, GG, D Naslain, F Bckhed, CS Reigstad, DM Lambert, et al. The Endocannabinoid
System Links Gut Microbiota to Adipogenesis. Molecular Systems Biology 6 (2010): 392. Print.
Naftali, T, L Bar-lev Schleider, I Dotan, EP Lansky, F Sklerovsky Benjaminov, and FM
Konikoff. Cannabis Induces a Clinical Response in Patients with Crohn's Disease: A
Prospective Placebo-Controlled Study. Clinical Gastroenterology and Hepatology 11.10
(2013): 1276-1280. Print.
Neuschwander-Tetri, Brent A. Food Energy Efficiency, Cannabinoids, and a Slow Death of the
Weight Loss Dogma. Hepatology 46.1 (2007): n.pag. Web.
Nguyen, BM, D Kim, S Bricker, F Bongard, A Neville, et al. Effect of Marijuana Use on
Outcomes in Traumatic Brain Injury. The American Surgeon 80.10 (2014): 979-983. Print.
OSullivan, SE. Cannabinoids Go Nuclear: Evidence for Activation of Peroxisome ProliferatorActivated Receptors. British Journal of Pharmacology 152.5 (2007): 576-582. Web.
Overton, HA, MC Fyfe, and C Reynet. GPR119, a Novel G Protein-Coupled Receptor Target
for the Treatment of Type 2 Diabetes and Obesity. British Journal of Pharmacology 153.S1
(2008): S76-S81. Web.
47

Pacher P, S Btkai, and G Kunos. The Endocannabinoid System as an Emerging Target of

Pharmacotherapy. Pharmacological Reviews 58.3 (2006): 389-462. Print.
Palermo, FA, G Mosconi, MA Avella, O Carnevali, MC Verdenelli, et la. Modulation of
Cortisol Levels, Endocannabinoid Receptor 1A, Proopiomelanocortin and Thyroid Hormone
Receptor Alpha mRNA Expressions by Probiotics During Sole (Solea solea) Larval
Development. General and Comparative Endocrinology 171.3 (2011): 293-300. Print.
Patel, S, and CJ Hillard. Role of Endocannabinoid Signaling in Anxiety and Depression.
Current Topics in Behavioral Neurosciences 1 (2009): 347-371. Print.
Penner, Elizabeth A, Hannah Buettner, and Murray A. Mittleman. The Impact of Marijuana Use
on Glucose, Insulin, and Insulin Resistance Among US Adults. The American Journal of
Medicine 126.7 (2013): 583-589. Print.
Physical Activity and Cancer. Cancer.gov. National Cancer Institute, n.d. Web. 21 Jan. 2015.
<http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity>.
Pieiro R, and M Falasca. Lysophosphatidylinositol Signalling: New Wine from an Old Bottle.
Biochimica et Biophysica Acta 1821.4 (2012): 694-705. Print.
Quistad, GB, SE Sparks, and JE Casida. Fatty Acid Amide Hydrolase Inhibition by Neurotoxic
Organophosphorus Pesticides. Toxicology and Applied Pharmacology 173.1 (2001): 48-55.
Print.
Rajesh, M, P Mukhopadhyay, S Btkai, et al. Cannabidiol Attenuates Cardiac Dysfunction,
Oxidative Stress, Fibrosis, and Inflammatory and Cell Death Signaling Pathways in Diabetic
Cardiomyopathy. Journal of the American College of Cardiology 56.25 (2010): 2115-2125.
Print.
Reynolds, Gretchen. How Exercise Benefits the Brain. NYTimes.com. The New York Times
Company, 30 Nov. 2011. Web. 21 Jan. 2015. <http://well.blogs.nytimes.com/2011/11/30/howexercise-benefits-the-brain>.
Riebe, CJ, and CT Wotjak. Endocannabinoids and Stress. Stress 14.4 (2011): 384-397. Print.
Rog, David J., Turo J. Nurmikko, Tim Friede, and Carolyn A. Young. Randomized, Controlled
Trial of Cannabis-Based Medicine in Central Pain in Multiple Sclerosis. Neurology 65.6 (2005):
812-819. Print.
48

Romero, J, L Garca, JJ Fernndez-Ruiz, M Cebeira, and JA Ramos. Changes in Rat Brain

Cannabinoid Binding Sites After Acute or Chronic Exposure to their Endogenous Agonist,
Anandamide, or to Delta 9-Tetrahydrocannabinol. Phamacology, Biochemistry, and Behavior
51.4 (1995): 731-737. Print.
Rousseaux, C, X Thuru, A Gelot, N Barnich, C Neut, et al. Lactobacillus Acidophilus
Modulates Intestinal Pain and Induces Opioid and Cannabinoid Receptors. Nature Medicine
13.1 (2007): 35-37. Web.
Seo, JY. The Effects of Aromatherapy on Stress and Stress Response in Adolescents. Journal
of Korean Academy of Nursing 39.3 (2009): 357-365. Print.
Shin, HS, KH Ryu, and YA Song. Effects of Laughter Therapy on Postpartum Fatigue and
Stress Responses of Postpartum Women. Journal of Korean Academy of Nursing 41.3 (2011):
294-301. Print.
Simopoulos, AP. The Importance of Omega-6/Omega-3 Essential Fatty Acids. Biomedicine &
Pharmacotherapy 56.8 (2002): 365-379. Print.
Singh, Y, and C Bali. Cannabis Extract Treatment for Terminal Acute Lymphoblastic Leukemia
with a Philadelphia Chromosome Mutation. Case Reports in Oncology 6.3 (2013): 585-592.
Web.
Sofi, F, C Macchi, R Abbate, GF Gensini, and A Casini. Effectiveness of the Mediterranean
Diet: Can it Help Delay or Prevent Alzheimers Disease? Journal of Alzheimers Disease 20.3
(2010): 795-801. Print.
Sparling, PB, A Giuffrida, D Piomelli, L Rosskopf, and A Dietrich. Exercise Activates the
Endocannabinoid System. Neuroreport 14.17 (2003): 2209-2211. Print.
Starowicz, K, W Makuch, M Osikowicz, F Piscitelli, S Petrosino, et al. Spinal Anandamide
Produces Analgesia in Neuropathic Rats: Possible CB(1)- and TRPV1-Mediated Mechanisms.
Neuropharmacology 62.4 (2012): 1746-1755. Print.
Steptoe, A, EL Gibson, R Vuononvirta, ED Williams, M Hamer, et al. The Effects of Tea on
Psychological Stress Responsivity and Post-Stress Recovery. Psychopharmacology (Berl) 190.1
(2007): 81-89. Web.
Strat, Yann Le, and Bernard Le Foll. Obesity and Cannabis Use: Results From 2 Representative
Surveys. American Journal of Epidemiology 174.8 (2011): 929-933. Print.
49

Supaat, I, Z Zakaria, O Maskon, A Aminuddin, and NA Nordin. Effects of Swedish Massage

Therapy on Blood Pressure, Heart Rate, and Inflammatory Markers in Hypertensive Women.
Evidence-Based Complementary and Alternative Medicine 2013 (2013): 171852. Web.
Suplita, RL 2nd, SA Eisenstein, MH Neely, AM Moise, AG Hohmann. Cross-Sensitization and
Cross-Tolerance Between Exogenous Cannabinoid Antinociception and EndocannabinoidMediated Stress-Induced Analgesia. Neuropharmacology 54.1 (2008): 161-171. Web.
Taren, Adrienne A., J. David Creswell, and Peter J. Gianaros. Dispositional Mindfulness CoVaries with Smaller Amygdala and Caudate Volumes in Community Adults. PLoS ONE 8.5
(2013): n.pag. Web.
Tashkin, Donald. Effects of Marijuana Smoking on the Lung. Annals of the American
Thoracic Society 10.3 (2013): 239-247.
Taylor, AG, AE Snyder, JG Anderson, CJ Brown, JJ Densmore, et al. Gentle Massage
Improves Disease- and Treatment-Related Symptoms in Patients with Acute Myelogenous
Leukemia. Journal of Clinical Trials 4 (2014): n.pag. Web.
Toguri, JT, C Lehmann, RB Laprairie, AM Szczesniak, J Zhou, et al. Anti-Inflammatory
Effects of Cannabinoid CB(2) Receptor Activation in Endotoxin-Induced Uveitis. British
Journal of Pharmacology 171.6 (2014): 1448-1461. Print.
Tth, A, PM Blumberg, and J Boczn. Anandamide and the Vanilloid Receptor (TRPV1).
Vitamins & Hormones 81 (2009): 389-419. Print.
Velasco, Guillermo, Cristina Snchez, and Manuel Guzmn. Towards the Use of Cannabinoids
as Antitumor Agents. Nature Reviews Cancer 12 (2012): 436-444. Print.
Verberne, L, A Bach-Faiq, G Buckland, and L Serra-Majem. Association Between the
Mediterranean Diet and Cancer Risk: A Review of Observational Studies. Nutrition and Cancer
62.7 (2010): 860-870. Print.
Vighi, G, F Marcucci, L Sensi, G Di Cara, and F Frati. Allergy and the Gastrointestinal
System. Clinical & Experimental Immunology 153.S1 (2008): 3-6. Print.
Vinod, KY, R Yalamanchili, S Xie, TB Cooper, and BL Hungund. Effect of Chronic Ethanol
Exposure and its Withdrawal on the Endocannabinoid System. Neurochemistry International
49.6 (2006): 619-625. Web.
50

Wade, Derick T., Philip Robson, Heather House, Petra Makela, and Julia Aram. A Preliminary
Controlled Study to Determine Whether Whole-Plant Cannabis Extracts Can Improve Intractable
Neurogenic Symptoms. Clinical Rehabilitation 17.1 (2003): 21-29. Print.
Waldman, M, E Hochhauser, M Fishbein, D Aravot, A Shainberg, et al. An Ultra-Low Dose of
Tetrahydrocannabinol Provides Cardioprotection. Biochemical Pharmacology 85.11 (2013):
1626-1633. Print.
Walsh, SK, CY Hepburn, KA Kane, and CL Wainwright. Acute Administration of Cannabidiol
in Vivo Suppresses Ischaemia-Induced Cardiac Arrhythmias and Reduces Infarct Size When
Given at Reperfusion. British Journal of Pharmacology 160.5 (2010): 1234-1242. Print.

Walther, Sebastian, Richard Mahlberg, Uta Eichmann, and Dieter Kunz. Delta-9Tetrahydrocannabinol for Nighttime Agitation in Severe Dementia. Psychopharmacology 185.4
(2006): 524-528. Print.
Wang, Q, X Li, Y Chen, F Wang, Q Yang, et al. Activation of Epsilon Protein Kinase CMediated Anti-Apoptosis is Involved in Rapid Tolerance Induced by Electroacupuncture
Pretreatment Through Cannabinoid Receptor Type 1. Stroke 42.2 (2011): 389-396. Print.
Weiss, L, M Zeira, S Reich, et al. Cannabidiol Arrests Onset of Autoimmune Diabetes in NOD
Mice. Neuropharmacology 54.1 (2008): 244-249. Print.

What is Cancer? Cancer.gov. National Cancer Institute, n.d. Web. 10 Jan. 2015.
<http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer>.
Wolf, SA, A Bick-Sander, K Fabel, P Leal-Galicia, S Tauber, et al. Cannabinoid Receptor CB1
Mediates Baseline and Activity-Induced Survival of New Neurons in Adult Hippocampal
Neurogenesis. Cell Communication and Signaling 8 (2010): 12. Web.
Woodward, Kristen. Exercise Reduces Chronic Disease Risks. FredHutch.org. Fred
Hutchinson Cancer Research Center, 1 Jul. 2007. Web. 1 Jan. 2015.
<http://www.fredhutch.org/en/news/center-news/2007/07/exercises-reduces-chronicdisease.html>.
Xu, X, Y Liu, S Huang, G Liu, C Xie, et al. Overexpression of Cannabinoid Receptors CB1 and
CB2 Correlates With Improved Prognosis of Patients With Hepatocellular Carcinoma. Cancer
Genetics and Cytogenetics 171.1 (2006): 31-38. Print.

51

Zhang, J, L Chen, T Su, F Cao, X Meng, et al. Electroacupuncture Increases CB2 Receptor
Expression on Keratinocytes and Infiltrating Inflammatory Cells in Inflamed Skin Tissues of
Rats. The Journal of Pain 11.12 (2010): 1250-1258. Print.

Zhuang, S, J Kittler, EV Grigorenko, MT Kirby, LJ Sim, et al. Effects of Long-Term Exposure

to Delta9-THC on Expression of Cannabinoid-Receptor (CB1) mRNA in Different Rat Brain
Regions. Molecular Brain Research 62.2 (1998): 141-149. Print.
Zimmer, Carl. How Microbes Defend and Define Us. NYTimes.com. The New York Times
Company, 12 Jul. 2010. Web. 19 Jan. 2015.
<http://www.nytimes.com/2010/07/13/science/13micro.html>.

52